Non-existence is hard to do

A review of  contemporary antinatalist writings

Originally published in Cryonics, 2nd Quarter, 2010 (PDF)

“Coming into existence is bad in part because it invariably leads to the harm of ceasing to exist.” David Benatar

If they could get a corpse to sit up on an operating table, they would jubilantly exclaim, “It’s alive!” And so would we. Who cares that human beings evolved from slimy materials? We can live with that, or most of us can.” Thomas Ligotti

The persistence of pessimism

When I sent out an email message soliciting contributions on the topic of philosophical pessimism and antinatalism one person declined with the reasonable response that such positions are only taken seriously by a handful of far-out philosophers. Humans have evolved to procreate and seek happiness. What is the point?

The reason why I have not been inclined to so easily dismiss the recent renaissance of philosophical pessimism is because negative and tragic views about life are woven throughout human history and culture. Most dominant religions have little positive to say about the state of humanity (after the fall) and the prospects for a life devoid of suffering on earth. Despite its relative sophistication, even Buddhism presents a picture of the universe as a source of suffering. Much can be said about pessimism but not that its influence is outside the mainstream.

Even the antinatalist position that it is better never to have been and that we have a moral obligation not to procreate is not completely obscure. Who has not had the experience of talking to the grumpy old lady who wonders why anyone would want to bring children into this world? We routinely dismiss such positions as being out of touch with reality but modern culture persists in linking intellectualism to pessimism. This perhaps should not be surprising because, as a general rule, excessive thinking comes at the expense of sensual experience. One reason why many intellectuals are biased towards pessimism is because it provides them the opportunity to rescue us with their ideas. Antinatalism offers the triumph of Reason against existence itself; the ultimate triumph of the Intellectual.

Philosophical aversion to pessimism can be found among the finest thinkers in the history of philosophy. There is David Hume, the great empiricist thinker, and an amiable and optimistic person. Then there is Friedrich Nietzsche, who, despite a life of disease and isolation, recognized that pessimism is not an objective feature of the universe but the expression of a weak and oversensitive mind. The twentieth century witnessed a strong renaissance of the empiricism of David Hume in the form of logical positivism. These philosophers rightly abstained from putting forward a “philosophy of life,” but optimism about science and humanity’s potential is clear in their foundational writings. It is also interesting to note that the most recent forceful responses to pessimism have not come from professional philosophers but from libertarian economists who do not display the slightest intellectual embarrassment in claiming that life is getting better all the time.

In my opinion, the most obvious question that can be raised about philosophical pessimism is whether its supporting claims are factual descriptions of reality or just expressions of temperament. Another interesting question is whether philosophical pessimism necessarily obliges us to the antinatalist position. In seeking answers to these questions we turn to the literature of contemporary antinatalism.

Jim Crawford’s Confessions of an Antinatalist is a highly readable autobiographical exposition of antinatalism. Thomas Ligotti’s book The Conspiracy Against the Human Race is more ambitious in scope and contains a wealth of historical information on pessimism, discussions of modern science, and, not surprisingly, a review of the theme of pessimism in horror literature. David Benatar’s Better Never to Have Been: The Harm of Coming into Existence is the most rigorous exposition of antinatalism to date. This book covers a lot of ground and I will confine myself to some of its main topics only.

The harm of coming into existence

In its purest form antinatalism may not be attainable but the framework that informs this position rests on a couple of sound premises: (1) we do not impose a harm (or withhold a benefit) by not bringing someone into this world; (2) we do impose a harm by bringing someone into the world when this person’s life will be bad. Jim Crawford believes that these premises are evident and I see little reason to dispute him. The real debate about antinatalism is how to determine that a person’s life is (or will be) bad, and how much consideration the interests of parents should be given.

One of the most problematic aspects about the work of Crawford and other antinatalists is that they have little patience for the argument that life is better than they think it is. In some passages it is hard to distinguish the antinatalist from the Marxist. If people think that life is much better than Crawford makes it out to be, the standard rejoinder is that these people suffer from a form of false consciousness (pessimists frequently use words like “truly” and “really”). In some passages this attitude borders on intolerance. A prime example can be found in Crawford’s discussion of childhood. For many people growing up was a period of great happiness and discovery. Crawford’s agitated dismissal of such accounts introduces an element of illiberalism in what is otherwise a humanistic endeavor. It is in these passages that antinatalism turns into bitter ideology.

The way the term “bias” is employed is deeply problematic. It is used as if there is an objective perspective that can reached were it not for those pesky evolutionary biases coming between the person and the universe. At times the author appears to be saying that if evolution did not select in favor of those wanting to survive we would not want to survive. This is not particularly helpful. Some of these “biases” do not cover up anything but just make us happier.

Let us assume here the metaphysical premise that there is an objective, material reality that can be known through the use of reason and empirical observation. This does not mean that there is one “correct” fit between an organism and the world. A person who is manically depressed perceives the world in a different matter than a person who is not. How we are “wired” and respond to our environment is not a matter of “correct” or “incorrect.” Thinking otherwise would be hard to reconcile with an evolutionary outlook in which life is just the outcome of random interactions of organic molecules.

One argument that remains available to the pessimist would be that the probability of creating a miserable life is too high to warrant procreation. But it is at this point that the “transhumanist” can enter the debate and claim that our expected quality of life is no longer just the outcome of a “random” evolutionary process but can be brought under rational control. We should endeavor to make happy children.

In my opinion, the short response to empirical pessimism can take the following form. Pleasure and pain are both part of existence. For some sentient beings pleasure outweighs pain, for other sentient beings pain outweighs pleasure. A moral agent cannot add up, subtract, or divide these elements for life as a whole to produce an objective quality-of-existence function. The antinatalist runs into the same problems as all the utilitarians and welfare economists who have tried to define a social utility function as a guide for public policy. As Thomas Ligotti notes in his book, “…the reason for the eternal stalemate between optimists and pessimists, is that no possible formula can be established to measure proportions and types of hurt and happiness in the world. If such a formula could be established, then either pessimists or optimists would have to give in to their adversaries.” I think that the best response available to the antinatalist would be to follow David Benatar’s example and present a strictly formal argument, or simply argue that in case of doubt, we should abstain from procreation.

Escape strategies

After spending the bulk of his book persuading the reader that life is suffering, Crawford discusses what he calls “Escape Strategies.” In his treatment of Buddhism as an escape strategy he could simply have made the obvious internal critique that desire may be sufficient, but not necessary for suffering. Crawford’s treatment of Christianity is scathing, which may indicate regret because the author himself was a Christian for awhile. Why have children if there is the prospect of eternal damnation? Good question, but I think that a Christian can respond by saying that following Scripture is more important than applying human morality to God’s creation.

The last escape strategy that Crawford reviews is hope, which turns into a discussion of futurism and transhumanism. The argument that many of those pursuing life extension will not be around to benefit from it is too simplistic. Unless the brain is completely destroyed at death, the neuro-anatomical basis of identity can be preserved at cryogenic temperatures for a very long time. No delusional expectations about the future are required. People in cryostasis have time. But then the author delivers a critique that I think deserves serious treatment by transhumanists (discussions about “friendly AI” do not exhaust this topic by any means). In a nutshell, we should not expect that technological progress will necessarily produce moral progress. And even if it will, accidents happen. Technologies that can be designed to produce great joy can be used to create great suffering as well. If humanity can manufacture hell without God, the case for pessimism and antinatalism may be strengthened.

Interestingly enough, the anticipation of such dark future technologies may present a (subconscious) obstacle for many people considering cryonics. Hundreds of millions of people believe in the craziest things like astrology and psychoanalysis, but only a handful of people (around 1500) have made cryonics arrangements. This lack of interest can  hardly be attributed to ignorance, and perhaps the most persuasive answer may be hidden in Crawford’s book. Cryonics basically forces people to deal with the question whether they would like to be “born again” in a far and unknown future. As a general rule, the answer seems to be “no.” Antinatalists may find additional ammunition for their position in studying the reasons for the low sign-up rate for cryonics.

Mahayana antinatalism

Antinatalists should expect a lot of obvious questions such as “are most people not glad to be alive?” or “why not kill yourself?” I fear that Crawford’s answer to the question “why not kill yourself?” risks undermining the orthodox antinatalist project. If empathic sensibility can make an enlightened antinatalist who wants to stick around it is arguable  that antinatalists should make an effort to remain alive in an effort to reduce the amount of (future) suffering in the universe. Antinatalists then become life extensionists. To use conventional Buddhist terminology, perhaps at some point there will be a Theravada version of antinatalism (focused primarily on non-procreation) and a Mahayana version of antinatalism (concerned with the elimination of the suffering of all sentient beings).

David Benatar runs into a similar problem when he ponders the question whether bringing new people into the world could be justified to reduce the suffering of the last remaining people. It seems to me that how an antinatalist deals with such practical moral issues depends on how the ethics of antinatalism is conceived. Do we have a “right” not to come into existence or is the objective of antinatalism to juggle with small and great suffering towards the ultimate end of its complete abolition?

If antinatalism is conceived as a strictly individualistic endeavor, concerns about the suffering of all humans can be easily dismissed. But in that case antinatalism would just collapse into individualist pessimism. Who cares about suffering, as long as it is not me! This is not the kind of sentiment that is generally found in antinatalist writings. I do not think that the question whether there might be moral reasons to remain alive, and, yes, bring into being forms of life that are benevolent but ruthless towards suffering, can be easily dismissed.

At one point Crawford observes that secular and smart people are having fewer children. This does not look good for the inevitable triumph of antinatalism. Under such scenarios antinatalism produces dysgenics, and if one believes that stupidity and evil go hand in hand, increased suffering for more people.

To me it is not unlikely that, in practice, antinatalism leads to more suffering because it will only be adopted by sympathetic human beings such as Crawford. The antinatalist cannot argue that the amount of suffering in the universe cannot be increased nor decreased. The whole point of antinatalism after all is that suffering can and should be decreased. But how to go about this may be more complicated than it appears. A sober assessment of the practical implications of antinatalism may require revision of the antinatalist position itself.

Confessions of an Antinatalist is a fine and humane book, but in the end it is also a book of the converted written for the non-converted. Thomas Sowell has noted that in economics there are no solutions but only trade-offs. I would not be surprised if antinatalists will come to a similar conclusion at some point.

Suffering without meaning

Thomas Ligotti is a contemporary horror writer whose fiction work  is marked by cosmic nihilism, alienation and the fragile nature of reality. As a great admirer of the work of Ligotti I have been reluctant to comment on his non-fiction. Fortunately, unlike many other artists, Ligotti has little interest in “critical theory” or “progressive” politics. His book The Conspiracy Against the Human Race: A Contrivance of Horror is not concerned with such trivial topics but with the bleak fate of humanity in a deterministic and indifferent universe.

The book starts off with an introduction by obscurantist philosopher Ray Brassier, whose work would certainly qualify for the description that Ligotti gives to Schopenhauer’s oeuvre (“too overwrought in the proving to be anything more than another intellectual labyrinth for specialists in perplexity”).

Reading Ligotti’s account of why humans reject truly bleak views about life it would be interesting to see how antinatalists respond to the existence of orthodox Calvinism. Accepting a universe without free will that is ruled by an omnipotent God who has decreed that the majority of people will suffer in hell for His self-glorification seems a lot more terrifying to me. Nonetheless, millions of people have accepted this theological perspective. The existence of Reformed theology lays to rest the view that humans have an intrinsic desire to avoid doctrines that are too terrible too contemplate.

When Ligotti discusses the work of antinatalist Peter Wessel Zapfe once more we find the view that there is an objective predicament of mankind that is hidden by false consciousness. It is remarkable to see the similarities between those who argue that we do not want look our “oppression” straight in the face and those who argue that we avoid coming to terms with the horror of existence. What  is often lacking here is the recognition that there is also a wealth of literature about human suffering that supports the idea that we would be happier if we did look nature straight in the face. No nonsense about “moral responsibility,” “sin,” “duty,” “the greater good” etc. Marquis de Sade, Friedrich Nietzsche, and Max Stirner are representatives of this school of thought.

What is intriguing about Ligotti’s book is that it reads like a rather delicate balancing act. On one hand, we have the detached observer (my favorite) who is bemused at the show business of both the optimists and pessimists. On the other hand, it is unmistakable that Ligotti feels affinity with the philosophers of cosmic horror and pessimism. His fiction does not leave much room for any other conclusion. But The Conspiracy Against the Human Race contains more than a few (unintended) suggestions how someone who declines to take sides would present his argument.

Hard determinism and the illusion of the self

I have a hard time relating to the Ligotti’s discussion about determinism and pessimism. Hard determinism (or hard imcompatibilism) is just a part of the “scientific worldview” and it is not obvious to me why it should be a source of despair. Ligotti then discusses the existence of the “self.” I am inclined to think there is an important difference between free will and the self. Modern science can make sense of the world and human action without assuming free will. I am  not convinced that this is possible if the concept of the self is rejected. Unlike free will, the recognition of a “self” comes at a later stage in evolution. It has been argued that primitive people could not clearly distinguish the self from its surroundings and thus were not able to discover the laws of physics and manipulate it to their benefit. The philosopher Hans Reichenbach developed a pragmatic case for the existence of the external world and the self in his seminal work Experience And Prediction: An Analysis of the Foundations And the Structure of Knowledge. Ultimately, the Kantian question whether something “really” exists (or what something “really” looks like) does not seem particularly helpful in the study of reality, as the early logical positivists of Vienna understood well.

Why would anything that neuroscientists discover about the self and how it is constructed be a source of dread? If you believe that life is just the result of random meetings of organic molecules, it stands to reason that the physical basis of consciousness and the self reflects such a process. Why would accepting such ideas make one a “heroic pessimist?” Why the pessimism at all? Ligotti even agrees. “One would think that neuroscientists and geneticists would have as much reason to head for the cliffs because little by little they have been finding that much of our thought and behavior is attributable to neural wiring and heredity rather than to personal control over the individuals we are, or think we are. But they do not feel suicide to be mandatory just because their laboratory experiments are informing them that human nature may be nothing but puppet nature. Not the slightest tingle of uncanniness or horror runs up and down their spines, only the thrill of discovery. Most of them reproduce and do not believe there is anything questionable in doing so.”

Ligotti also discussed transhumanism, but not in much depth. As a transhumanism skeptic myself, I found little to object to but it seems that Ligotti’s real target is what is called Singularitarianism. This part in the book seems something of a missed opportunity because there is substantial overlap between Ligotti’s fiction and themes that are discussed by transhumanist writers: living in a computer simulation, parallel universes, alternate realities etc.

When Ligotti reviews near-death experiences and ego-death, the common-sense neurological explanations that were invoked in discussions of free will and the self are largely absent (a notable exception is his discussion of the possibility that a brain tumor can cause such an “enlightened” state). For critical-care physicians it is a given that many people suffer (regional) cerebral ischemia during the dying process. As such, it is surprising (but encouraging) that not more people claim enlightenment after they recover. These periods of  transient oxygen deprivation can produce long term damage and a “re-wiring” of the brain, which can explain the new perspectives these people adopt. From a physicalist perspective, death of the ego is (partial) death of the brain, something one may or may not want to celebrate.

In Ligotti’s book the reason for pessimism is multi-factorial. It includes the lack of meaning in an indifferent universe, the reality of hard determinism, and the illusion of the self. The works of Benatar and Crawford are more restricted in scope and mostly focus on more mundane suffering. Ligotti’s philosophical horror is much richer, but I wonder how much of it will resonate with people who embrace a scientific view of the universe. The Conspiracy against the Human Race may not have been designed as an argument against “unweaving the rainbow” (to use Richard Dawkin’s useful phrase) but it sometimes reads like one.

There is a lot in Ligotti’s fine book that I have not discussed such as the extensive treatment of pessimism in horror fiction, loads of interesting philosophical and scientific references, plus illuminating discussions of obscure authors such as Peter Wessel Zappfe and Philipp Mainlander. As such, it can also be considered as an indispensable reference for philosophical pessimism and cosmic horror.

Empiricism and non-existence

David Benatar is a rigorous philosopher. His work can be situated in the analytic tradition and he makes an honest attempt to anticipate objections to his own views. When he argues for positions using mainly logical arguments he is quite persuasive. A being that does not exist can neither be harmed nor benefited. I cannot see how this argument (or  tautology?) can be successfully refuted. But when Benatar attempts to argue that the quality of life of most people is much worse than they think it is, multiple challenges arise. I do not think this is the result of Benatar’s poor reasoning but because the fields that he relies on – evolution, social psychology, happiness research and the study of cognitive biases – are notorious for allowing competing views. It seems to me that ultimately Benatar cannot escape the charge that he pays excessive attention to theories that claim that we think we are happier than we really are. Perhaps I have spent too much time in the wrong subculture but it seems to me that the phenomenon of people claiming to be less happy than they really are should not be ignored either.

Like Crawford, Benatar cannot completely escape the charge of illiberalism. Classical liberalism takes very seriously the challenges in reaching satisfactory conclusions about the quality of other people’s lives. In practice this means that we exercise restraint in making strong cognitive and moral claims about the feelings and preferences of other people. This is a mindset that does not seem to come easily to antinatalists. Benatar is on more agreeable ground when he simply derives his antinatalism from uncertainty; “some know that their baby will be among the unfortunate. Nobody knows, however, that their baby will be one of the allegedly lucky few.”

Benatar believes that even if his empirical argument about the poor quality of our lives fails, his formal argument from asymmetry is still left standing. He thinks that even if there is one single painful pinprick in an otherwise good life, we still harm that person by bringing him into existence. I think that Benatar is “proving” too much here. We can agree that anyone who conceives a child cannot escape the prospect that this person will experience some harm. But from this it does not follow that the person is harmed in a meaningful moral sense without considering the expected overall quality of that life. Perhaps Benatar would respond that I have not understood his argument, and I will admit that I have a difficult time understanding why the possibility that a person’s pleasures are expected to outweigh the pains do not alter his argument. I think that both bringing into existence a life that is invariably good and a life that is generally good can be morally defended on the grounds that there will not be any post-natal moral objections from the person involved. Of course, we are not morally obliged to do so, because we will not deprive the unborn of such a good life if we don’t have children. But since most parents have a positive interest in having children, in practice this tips the scales in favor of some (but not all!) procreation. One problem I can see with my argument is that it might permit the creation of a life form that would experience great suffering but with an unalterable survival instinct and no cognitive possibility of moral blame or regret. Some antinatalists might even claim that this is a rather accurate description of the human race as it exists today.

As an empiricist, I generally give the benefit of doubt to empirical observations when they appear to conflict with logical reasoning. I think that this preference itself can be justified on historic and pragmatic grounds. The claim that coming into existence is always a harm is not consistent with the reports of all those who have come into existence. That seems to be a non-trivial epistemological roadblock for antinatalism.

When Benatar discusses the moral duty not to have children he runs into the obvious problem of how the interests of the parents should be weighed against the interests of the child. One does not need to be an ethical egoist to believe that the interests of the parents count for something. In this case the question returns to how bad the life of most people is and, as discussed, this is a rather vulnerable part of antinatalism. Benatar attempts to answer the obvious objection that most people who have been born do not regret this or blame their parents. But when I read his thoughts on “indoctrination” I only see further evidence of the anti-liberalism in his writings.

In fairness to Benatar (who seems to identify himself as a liberal of some sorts), he does defend the legal right to procreation because he admits that there can be reasonable disagreement about his views. I think this point is particularly important for antinatalism since reasonable objections often come from the very people whose lives Benatar characterizes as very bad. That is not to deny that society can choose to be less supportive of people who engage in reckless procreation. Such behavior can be substantially decreased by withholding benefits that encourage or reward such behavior. Benatar correctly argues that if one subscribes to a consistent interpretation of the Kantian argument that future people should not be treated as means, then all reproduction is morally dubious. But whether that highlights the virtues or defects of Kant’s ethics I leave to the reader to ponder.

Benatar highlights the importance of making a distinction between the decision to bring someone into existence and the decision to continue life. Even if we commit to the idea that it is better never to have been we can still have reasons for wanting to continue life. As a matter of fact, Benatar entertains the argument that the prospect of death itself is one of the reasons why existence is bad. Those who follow Epicurus believe that death cannot be experienced and thus cannot be a bad thing for the person. This is an extremely difficult argument to refute, but Benatar’s discussion of this topic is quite illuminating because he points out that those who hold this position may also have to commit to the view that death can never be good for a person. One only needs to imagine a person whose life is one of continuous suffering to see that this is not a plausible argument.

As an academic Benatar is less hostile to religion than Crawford and Ligotti but I do not think he can successfully escape the objection that antinatalism requires an atheist perspective. One does not have to be a scripturalist to note that Benatar is only concerned with the fate of humans and not with the interests of God. Perhaps Benatar cannot see any positive value in human suffering because his information about Creation is incomplete. Theodicies that reconcile the existence of God and the existence of Evil are not difficult to generate. As Plotinus has observed, “We are like people ignorant of painting who complain that the colours are not beautiful everywhere in the picture: but the Artist has laid on the appropriate tint to every spot.”

Antinatalists and life extensionists

One would think that cryonicists and life extensionists should be repulsed by antinatalism. I think such a view would be mistaken. All the antinatalist authors discussed here are motivated by empathy for the suffering of all sentient life. We should also welcome the analytical and physicalist perspectives that underpin their writings. Too much (Continental) philosophy is simply an insult to the intellect and a waste of time. If a case should be made for pessimism it needs be stated in a form that is amenable to reasoned debate and empirical investigation.

Of more specific interest to life extensionists is the plausible prospect that our abilities to decrease suffering will (necessarily?) be matched by our abilities to increase suffering too. This is a possibility that should be studied in great detail by advocates of molecular nanotechnology, strong AI, and Substrate Independent Minds.

It is no secret that cryonicists are underperforming in terms of reproduction. But as Howard V. Hendrix discusses in the article “Dual Immortality, No Kids: The Dink Link between Birthlessness and Deathlessness in Science Fiction,” this may not be a coincidence. If biological immortality becomes a credible option, having children as a substitute for personal survival will lose much of its appeal.

Most rewarding for cryonicists is the unique perspective that antinatalists can bring to the debate concerning why so few people have made cryonics arrangements. The hostility of many people towards cryonics cannot be explained if people categorically believe that  meaningful resuscitation (revival) is impossible. It is the prospect that cryonics may actually work that induces severe anxiety. If the antinatalists are correct in their assessment that coming into existence is always a harm, the unpopularity of cryonics might be indirect evidence for their position.

I want to close this review with one word of advice to those who engage in debates with antinatalists. Most antinatalists waste little time reminding their readers how controversial their ideas are. They think that they have uncovered the greatest taboo of all time. As an empirical matter, this is doubtful. Antinatalist ideas can be freely discussed in modern Western countries, something that cannot be said about a number of other controversial ideas. Antinatalists are also quick to point out that their pessimism should not be dismissed as an expression of weakness and depression. But then the antinatalists commit a similar error by too easily viewing optimism as a defense mechanism or a form of bias. But is it completely unreasonable to look for the neurophysiologic and genetic basis of pessimism and optimism? The uncompromising naturalism in the work of the antinatalists  supports such an inquiry.

Jim Crawford: Confessions of an Antinatalist (Nine Banded Books 2010)

Thomas Ligotti: The Conspiracy Against the Human Race: A Contrivance of Horror (Hippocampus Press 2010)

David Benatar: Better Never to Have Been: The Harm of Coming into Existence (Oxford University Press 2006)

Thanks to Dr. Michael Perry for discussing some of the topics in this review and proofreading an earlier version of this document.

At last, a sure-cold way to sell cryonics with guaranteed success!

A humorous romp through a promising new technique in aesthetic medicine from one cryonicist’s (warped) point of view.

Figure 1: Before cryopreservation (L) and after cryopreservation (R).

As everyone involved in cryonics for more than a fortnight is sadly aware, cryonics doesn’t sell. Indeed, if we were pitching a poke in the eye with a sharp stick, we’d more than likely have more takers than we’ve had trying to ‘market’ cryonics to the public. To see evidence that this is so, you need only wander around a shopping mall on a weekend and observe all the (painfully) stainless steel lacerated and brightly colored needle-pierced flesh sported by the young and trendy and increasing by the old and worn, as well.

Yes, it’s clear; we misread the market, to our lasting detriment.

It’s true that we’ve tried the ‘you’ll be rich when you wake you up line,’ and heaven knows we’ve beaten the ‘you’ll be young and beautiful forever’ line, well, virtually beaten it to death. And while people are certainly interested in great fortune and youth, both of these things share the same unfortunate shortcoming, namely that they are things that people either don’t have but want, or do have and don’t want to lose. As anyone who is really savvy at marketing will tell you, the best way to sell something is to promise (and preferably be able to deliver) that you can get rid of something that people have and really don’t want – something that is ruining the quality of their life, destroying their health, draining their pocketbook and, worst of all, making them really, really ugly.

So, it turns out that for onto 50 years now, we’ve missed the real selling point of cryonics that’s been there all along: IT WILL MAKE YOU THIN! Guaranteed!

Can such a claim be true? Well, surprisingly, the answer would seem to be an almost unqualified, “Yes!”

Recently it’s been discovered that adipocytes, the cells responsible not only for making you fat, but for making you hungry, as well, are particularly susceptible to a phenomenon in cryobiology that has proved a nettlesome (and only recently (partially) overcome) barrier to solid organ cryopreservation: chilling injury. Quite apart from freezing damage due to ice crystals forming, adipocytes are selectively vulnerable to something called ‘chilling injury.’ 1-5 Chilling injury occurs when tissues are cooled to a temperature where the saturated fats that comprise their cell membranes (external and internal) freeze. You see, saturated fat, which is the predominant type of fat in us humans, freezes well above the temperature of water – in fact, it freezes at just below room temperature. That’s why that big gash of fat on the edge of your T-bone steak is stiff and waxy when it is simply refrigerated, and not frozen.

Figure 2: Chilling injury is thought to result from crystallization of cell membrane lipids.

Chilling injury isn’t really well understood. In the days before both cryobiology and indoor heating, humans used to experience a very painful manifestation of it in the form of chilblains – tender swelling and inflammation of the skin due to prolonged cold exposure (without freezing haven taken place). In the realm of organ preservation it is currently thought that chilling injury occurs when cell membranes are exposed to high subzero temperatures (-5oC to -20oC), again, in the absence of freezing.

There is evidence that the lipids (fats) that make up the smooth, lamellar cell membranes undergo crystallization when cells are cooled much below 0 deg C. Since the crystals are hexagonal in shape and have a hole in the middle, this has the effect of creating a pore or hole in the membrane. Cells don’t like that – those holes let all kinds of ions important to cells keeping their proper volume and carrying on their proper metabolic functions leak in and out, as the case may be. This isn’t merely an inconvenience for cells, it’s downright lethal. Without boring you with technical details, it is possible to partially address this state of affairs in organ preservation by adjusting the ‘tonicity’ of the solution bathing the cells: oversimplifying even more, this means by increasing  the concentration of salts to a concentration higher than would normally be present

Figure 3: Contouring of the skin in a pig subjected to brief, subzero cooling of subcutaneous fat.

But, to return to our chilled adipocytes and the promise not only of weight loss, but of a fat-free future; adipocytes are killed, en masse, when their temperature is dropped to between 0 and -7oC. Within a few days of exposure to such temperatures they undergo programmed cell death (apoptosis) and within a couple of months they are phagocytized by the body; and all that ugly and unwanted fat is carted off to be used as fuel by the liver. Now the rub would seem to be that this effect is most pronounced when the temperature of the tissue is cooled to below the freezing point of water and held there – preferably for a period of 10 minutes or longer.

That sounds dire, doesn’t it? What about the skin, the fascia, blood vessels, and the other subcutaneous tissues that will FREEZE (in the very conventional sense of having lots and lots of ice form in them)? Well, the answer, as any long-time experimental cryobiologist will know (even if he won’t tell you) is: pretty much nothing. Way back in the middle of the previous century, a scientist named Audrey Smith and her colleagues at Mill Hill, England found that you could freeze hamsters ‘solid’ – freeze 70+% of the water in their skin and 50% of the water in their bodies – and they would recover from this procedure none the worse for wear. Similarly, those of us who have carelessly handled dry ice for a good part of our lives will tell you that we see parts of our fingertips turn into stiff chalky islands of ice all the time, with the only side effect being a bit of temporary numbness that resolves in a few days to a week – certainly a side effect well worth it to avoid the considerable inconvenience of rummaging around to find a pair of protective gloves.

Figure 4: The Zeltiq Cool Sculpting Cryolipolysis device.

But alas, we scientists (most of us, anyway) are not a very entrepreneurial lot, and so we never thought either of inventing the ZeltiqTM cryolipolysis system, or using ‘the thin-new-you’ as a marketing tool for cryonics.

Yes, that’s right; some very clever folks have found a way to make a huge asset out of a colossal liability – to organ preservationists, anyway. Around 2004 a Minneapolis dermatologist named Brian Zellickson, MD, who specialized in laser and ultrasonic skin rejuvenating procedures, made a not so obvious connection. Both laser and skin ‘face-lifting’ and skin ‘rejuvenation’ procedures rely on the subcutaneous delivery of injuring thermal energy to the tissues of the face, or other treated parts of the body (cellulite of the buttocks and thighs are two other common areas for treatment). These energy sources actually inflict a second degree burn in a patchy and well defined way to the subdermal tissues.

Now this may seem a very counterintuitive thing to do if you are trying to induce ‘rejuvenation’ or ‘lift’ a sagging face. But if you think about it, it makes a great deal of sense. As any burn victim will tell you, one of the most difficult (and painful) parts of recovery is stretching the highly contracted scar tissue that has formed as a result of the burn injury. Indeed, for many patients with serious burns over much of their body, the waxy, rubbery and very constricting scar tissue prevents the return of normal movement, and can lock fingers and even limbs into a very limited range of motion. Many burn victims must do painful stretching exercises on a daily basis to avoid the return of this paralyzing skin (scar) contracture.

And it must be remembered that aged skin – even the skin of the very old – can still do one thing, despite the many abilities it has lost with age, and that thing is to form scar tissue in response to injury. Thus, laser and ultrasonic heating of normal (but aged) skin induces collagen proliferation and large-scale remodeling of the skin. For all the bad things said about scar tissue it is still a remarkable achievement in that it does constitute regenerated tissue. Regenerated tissue which does the minimum that normal skin must do to keep us alive: provide a durable covering that excludes microbial invasion, and prevents loss of body fluids. By injuring the tissue just below the complexly differentiated layer of the dermis (with its hair follicles, sweat glands and highly ordered pigmentation cells) much of the benefit of ‘scarring’ is obtained without the usual downsides.

The injured tissues respond by releasing collagen building cytokines as well as cytokines that result in angiogenesis (new blood vessel formation) and widespread tissue remodeling. And all that newly laid down collagen contracts over time, tightening and lifting the skin – and the face it is embedded in. These techniques may justly be considered much safer versions of the old fashioned chemical face peel, which could be quite effective at erasing wrinkles and achieving facial ‘rejuvenation,’ but was not titrateable and was occasionally highly unpredictable: every once in awhile the result was disastrous burning and accompanying long term scarring and disfiguration of the patient’s face.

St some point Dr. Zellickson seems to have realized that the selective vulnerability of adipocytes to chilling offered the perfect opportunity for a truly non-invasive approach to ‘liposuctioning’ by using the body’s own internal suctioning apparatuses, the phagocytes, to do the job with vastly greater elegance and panache than any surgeon with a trocar and a suction machine could ever hope to do. Thus was invented the Zeltiq Cool SculptTM cryolipolysis machine.6

Figure 5: The cooling head of the Zeltiq devive equipped with ultrasonic imaging equipment and a suction device to induce regional ischemia and hold the tissue against the cooling surface.

The beauty of cryolipolysis is that it is highly titrateable, seems never to result to in excessive injury to, or necrosis of the overlying skin, and yields a smooth and aesthetically pleasing result. Not unjustifiably for this reason it is marketed under the name Cool SculptingTM. The mechanics of the technique are the essence of simplicity. The desired area of superficial tissue to be remodeled is entrained by vacuum in a cooling head equipped with temperature sensors, an ultrasonic imaging device, and a mechanical vibrator. The tissue in the cooling head is sucked against a conductive surface (made evenly conductive by the application of a gel or gel-like dressing to the skin) where heat is extracted from it. The tissue is cooled to a temperature sufficient to induce apoptosis in the adipocytes, while at the same time leaving the overlying skin untouched. The depth of cooling/freezing is monitored by ultrasound imaging and controlled automatically by the Zeltiq device.  At the appropriate point in the cooling process the tissue is subjected to a 5 minute period of mechanical agitation (massage) which helps to exacerbate the chilling injury, perhaps by nucleating the unfrozen fat causing it to freeze.7 When the treatment is over, the device pages an attendant to return to the treatment room and remove it.

The tissue under vacuum is also made ischemic – blood ceases to flow, and this has the dual advantage of speeding the course of the treatment by preventing the blood borne delivery of unwanted heat – and more importantly, by making the cooling more uniform, predictable and reproducible. It also has the effect of superimposing ischemic injury on top of the chilling injury which is something that seems to enhance adipocyte apoptosis. The whole treatment, in terms of actual cooling time, takes about 60 minutes. In the pig work which served as the basis for the human clinical treatments, the duration of treatment was only 10 minutes: but the cooling temperature was also an ‘unnerving’ -7oC. The degree of temporary and fully reversible peripheral nerve damage (that temporary numbness us ‘dry ice handlers’ know so well) was more severe at this temperature, although it resolved in days to a week or two, without exception.

As previously noted, cryolipolysis causes apoptosis of adipocytes and this results in their subsequently being targeted by macrophages that engulf and digest them. This takes time, and immediately after treatment there are no visible changes in the subcutaneous fat. However, three days after treatment, there is microscopic evidence that an inflammatory process initiated by the apoptosis of the adipocytes is underway, as evidenced by an influx of inflammatory cells into the fat of the treated tissues. This inflammatory process matures between seven and fourteen days after treatment; and between fourteen and thirty days post-treatment, phagocytosis of lipids is well underway. Thirty days after treatment the inflammatory process has begun to decline, and by 60 days, the thickness of interlobular septa in the fat tissue has increased. This last effect is very important because it is weakness, or failure of the interlobular fat septae that is responsible for the ugly ‘cottage cheese’ bulging that is cellulite. Three months after the treatment you get the effect you see below on the ‘love handles’ of this fit, and otherwise trim fellow. Thus, it is fair to say that Cool SculptingTM is in no way a misnomer.

Figure 6: Art left is a healthy, fit young male who has persistent accumulation of fat in the form of ‘love handles’ that are resistant to diet and exercise and the same man 3 months after cryolipolysis.

Does cryolipolysis really work? The answer is that it works extremely well for regional remodeling or sculpting of adipose tissue – those pesky love handles, that belly bulge around the navel, that too plump bum, or those cellulite marred thighs. So far it has not been used to try and ablate large masses of fat – although there seems no reason, in principal, why this could not be done using invasive techniques such as pincushioning the fat pannus with chilling probes, as is done with cryoablation in prostate surgery. However, this would be invasive, vastly more expensive, and likely to result in serious side effects.

And that was one of the really interesting things about the research leading up to FDA approval of cryolipolysis: it seems to cause no perturbation in blood lipids, no disturbance of liver function (the organ that has to process all that suddenly available fat) and no global alterations in immune function. It seems to be safe and largely adverse effect free. There is some localized numbness (as is the case in freezing of skin resulting from handling dry ice) but it resolves without incident with a few weeks of the procedure.8

So, all of this makes me wonder, since human tissues tolerate ice formation and respond to it in much the same way as they do to laser or ultrasound ‘rejuvenation’ (depending upon the degree of damage) a logical question is, “would it be possible to use partial freezing of the skin – just enough to provoke the remodeling response – as a method of facial rejuvenation?” It should be safer than a chemical people and it is, like laser and ultrasound therapy, titrateable.

Figure 7: “Gad darn it, this shiny gold stuff keeps getting into the silt I’m tryin to git out of this here river!”

Which returns me to the whole subject of cryonics: fat is very poorly perfused and it seems unlikely that things done to moderate or abolish chilling injury will be nearly so effective for the adipocytes in fat (if it they are effective at all). That means that we might well all come back from our cryogenic naps not only young, via the magic of nanotechnology and stem cell medicine, and rich via the miracle of compound interest (which none other than Albert Einstein once remarked was “the most powerful force in the universe”), but also THIN! For all these years organ cryopreservationists, like Fahy and Wowk, have been panning for the mundane silt of a way around a chilling injury9 all the while discarding the gleaming nuggets of gold that were persistently clogging up their pans.

We cryonicists should not repeat their error and should realize a good thing when we see it. Now, for the first time, we can credibly claim that if you get cryopreserved you’ll come back not only young and rich, but young and rich and beautiful and thin!

Methinks there must be very few in the Western World today, man woman or child, who can resist a product that has all that to offer – and which, by the way, bestows practical immortality in the bargain.

Ok, Ok, maybe we shouldn’t mention that last part about immortality; it might scare the children.

REFERENCES:

1)     Wiandrowski TP, Marshman G. Subcutaneous fat necrosis of the newborn following hypothermia and complicated by pain and hypercalcaemia. Australas J Dermatol 2001;42:207–10.

2)     Diamantis S, Bastek T, Groben P, Morrell D. Subcutaneous fat necrosis in a newborn following icebag application for treatment of supraventricular tachycardia. J Perinatol 2006;26:518–

3)     Lidagoster MI, Cinelli PB, Levee´ EM, Sian CS. Comparison of autologous fat transfer in fresh, refrigerated, and frozen specimens: an animal model. Ann Plast Surg 2000;44:512–5.

4)      Wolter TP, von Heimburg D, Stoffels I, et al. Cryopreservation of mature human adipocytes: in vitro measurement of viability. Ann Plast Surg 2005;55:408–13.

5)      Manstein D, Laubach H, Watanabe K, Farinelli W, Zurakowski D, Anderson RR. Selective cryolysis: a nivel method of noninvasive fat removal. Lasers Surg Med 2008;40:595–604.

6)     Avram MM, Harry RS. Cryolipolysis for subcutaneous fat layer reduction. Lasers Surg Med. 2009 Dec;41(10):703-8. Review. PubMed PMID: 20014262.

7)     Zelickson B, Egbert BM, Preciado J, Allison J, Springer K, Rhoades RW, Manstein D. Cryolipolysis for noninvasive fat cell destruction: initial results from a pig model. Dermatol Surg. 2009 Oct;35(10):1462-70. Epub 2009 Jul 13. PubMed PMID: 19614940.

8)     Coleman SR, Sachdeva K, Egbert BM, Preciado J, Allison J. Clinical efficacy of noninvasive cryolipolysis and its effects on peripheral nerves. Aesthetic Plast Surg. 2009 ul;33(4):482-8. Epub 2009 Mar 19. PubMed PMID: 19296153.

9)     Fahy GM, Wowk B, Wu J, Phan J, Rasch C, Chang A, Zendejas E. Cryopreservation of organs by vitrification: perspectives and recent advances. Cryobiology. 2004 Apr;48(2):157-78.

Historical Death Meme

There’s a pretty simple explanation as to where motivated skepticism for cryonics originates. If you currently are skeptical of cryonics, you should carefully consider whether this applies.

Historically, there has been a powerfully optimized meme regarding the topic known as death. If you lost vital signs, you were irrevocably lost. There was nothing that could be done. The belief evolved that there is a mysterious point termed “death” which is in principle irreversible.

From this we developed a custom of honoring or dishonoring people who no longer exist by the mechanism of treating their corpse in certain ways. When criminals were were beheaded with their heads rolling around on the ground and subsequently being stuck on a pike, it was a highly visible sign of disrespect and disgust for the kind of life lived by the deceased. Similarly, steps taken to reduce grotesque appearance of the corpse by embalming or cremation have evolved as a token of respect.

This notion of “rewarding” or “punishing” people after their death serves purely as a signal to the living as to what kind of life should be considered worth living. Likewise, a person’s final moments take on a special significance, despite being just a tiny fraction of their total lifespan. What were they doing when they went? Were they anxious, or accepting? There is a certain poignancy of accepting death rather than fighting, which I imagine a hospice worker like Peggy Jackson would easily relate to. Collectively these special attitudes towards the experience in one’s final moments and state of one’s remains after death are the Historical Death Meme (HDM).

Now, bring cryonics into the picture. The cessation of vital signs is no longer a sign of irreversibility-in-principle. The best mechanism for survival at this point is stabilization followed by cryopreservation. Stabilization is not a cosmetically appealing procedure. If stabilization happens late, this causes disfiguring edema. The scientific fact that it is the best hope the patient has for preserving their brain structure is overshadowed by the cosmetic details — purely because of the HDM.

But this isn’t the only big issue. The bigger issue, which I think is where the bulk of the hostility originates, is that the HDM itself begins to look ethically questionable once you begin to consider that cryonics is admissible. In preparing someone’s corpse, in ignoring their ischemic state as soon as vital functions appear irrecoverable to today’s technology, you are doing the patient a disservice. It’s not just a disservice, but potentially fatal disservice. In fact, by denying them their one shot at life you are showing them a sort of disrespect.

In other words, the perfect conditions for cognitive dissonance have been established. The HDM is highly valued, and an integrated part of the identity of practically our whole society. Doctors must be comfortable giving up on patients, and morticians must be comfortable doing cosmetic rather than life-saving surgery. Heirs must be comfortable taking money that could have been used to cryopreserve their parents and grandparents. To admit that cryonics has a valid chance of working, is affordable, is ethically motivated, and is seriously scientifically motivated and well-researched, would be to strip them of that comfort.

The feelings of unease must be transferred to cryonics as a means of keeping the HDM from appearing unethical, silly, prescientific, and superstitious. Since cryonics is relatively unfamiliar (in terms of the supporting science and actual practice) and has a variety of associations with science-fiction’s hand-waving plot devices and religion’s resurrection fantasies, a motivated skeptic need not work very hard to make themselves feel this way.

The diminishing returns of reactive medicine

In an article for Slate, Jay Olshansky argues in favor of a position that one would expect to be common sense at this point:

While we can extend life in aging bodies through behavioral improvements and medical treatments, the time has arrived to acknowledge that our current model of reactive medicine, of trying to treat each separate disease of old age as it occurs, is reaching a point of diminishing returns.

So what is the reason why vast amounts of money are spent on research to treat age-associated diseases but so little on eliminating or mitigating aging as such? Why is this “one-disease-at-a-time model” so dominant? One reason might be that most people believe that overcoming one specific manifestation of aging is easier to do than overcoming aging itself. Not surprisingly, most academic and commercial research is shaped by short term ambitions or short-term financial interests.

Many people who deal with serious age-associated diseases hope that a cure can be found within their lifetime.  This is not so strange if you consider that many people who do advocate meaningful rejuvenation research are technological optimists who think the same thing about overcoming aging. In that sense, people show little interest in supporting research that has little personal benefit to them or close relatives. This is further evidenced by the fact that people are more inclined to contribute to anti-aging efforts that promise benefits in their lifetime. This in turn provokes criticism from mainstream scientists of not being realistic, which further discredits the field.

But as Olshansky indicates, the diminishing returns of the approach to just fight the symptoms of aging should force people to change perspective. Olshansky also observes  that “manufacturing survival time in the absence of decelerated aging” can produce a lot of hardship and suffering in old age:

It’s important to acknowledge the fundamental differences between disease and aging. Although age-associated changes in the body produce an increased risk of disease, the reverse is not true. That is, reducing the risk of disease has no influence on biological aging. Thus, if a population is preserved with increasing efficiency by advances in technology that reduce the risk of disease, those saved will live into increasingly later sections of the lifespan where aging takes a greater toll on body and mind. Life extension achieved in this way could extend old age by exposing survivors to the high-risk conditions of frailty that are common, and largely immutable, near the end of life—the very outcome that medicine and public health practitioners are trying to avoid.

For people who have made cryonics arrangements, there is another danger; the possibility of life extension at the price of increased vulnerability to identity-destroying diseases.  There is no shortage of cryonics patients with Alzheimer’s or impaired brain function. As much as we would like to deny it, there could be a disturbing trade-off between life extension and true personal survival as long as treatments for neurodegenerative diseases are not available.

Cryonics, trans-temporal communism and future squatters

Cryonics advocate Eugen Leitl puts forward some hard-hitting and thought-provoking observations about cryonics (reminiscent of Mike Darwin’s more recent thoughts on the subject):

Cryonics, like Natural Selection, or the theories of General and Special Relativity, is core-smashing in character, and in the case of cryonics, the idea is so antithetical to the existing order of civilization that it can it only be advanced by insurgent means. This is so because cryonics overturns the Vitalistic view of life, challenges the conventional definition of death, invalidates the core tenets of contemporary medicine, erodes the need for a mystical afterlife, radically redistributes capital (disrupts inheritance, bequests, and mortuary customs), mandates a complete change in reproductive behavior, perturbs generational succession, requires space colonization, requires (and supports) profoundly disruptive technologies such as cloning, regenerative medicine, nanotechnology, artificial intelligence, and finally, ends the species and enables, if not requires Transhumanism. As a consequence, cryonics creates adverse emotional and intellectual states within the existing culture such as survivorship guilt, indefinitely extended anxiety and uncertainty accompanying life-threatening illness (the cryonics patient remains ‘critically ill’ for decades or centuries), prevents the psychological closure that accompanies “true” death with disposition of remains, creates indefinite anxiety about the well being of cryopreserved loved ones, disrupts the intimacy of family interactions during the “dying” process, may bitterly divide family members who are opposed to cryonics versus those who are in favour, and blocks or disrupts deeply held mechanisms for coping with death and bereavement that are inculcated from childhood by eliminating the customary wake, funeral, and other comforting rituals.

In particular, he opines that “the idea that cryonics was just an extension of medicine and is compatible with religion and existing social and political institutions, while superficially satisfying, is both mistaken and bound to fail.” After this observation one would expect him to advocate some radical form of transhumanism as a vehicle to promote cryonics. But he further believes that:

Distinct from initialization failures, there are inherent in cryonics several corrosive and self destructive ideas that have grown over time until they have virtually overwhelmed cryonics today. The first of these is “temporal load shifting,” or more colloquially, the problem of ‘our friends in the future…his causes cryonicists to increasingly shift the burdens, technological and financial, present and future, onto the people (supermen) who we believe will revive us from cryopreservation, a concept that may fairly be called Trans-Temporal Communism: from cryonicists now according our ability (none); and from our ‘supermen friends in the future’ according to our needs (infinite). Trans-Temporal Communism leads to the creation of ‘Future Squatters; people who believe that technological advances will happen when conditions are right for them to occur. This is a brilliant position because it is never wrong; it is the perfect piece of circular reasoning that justifies doing nothing. This creates a perverse situation wherein intelligent and talented people who enter cryonics do not, as might at first be thought, find it impossible to believe that cryonics, vast extension of the human life span, or, for that matter, many of the transformational technologies of Transhumanism are impossible, but rather they that find it not only believable, but inevitable that these developments will occur within their lifetimes (i.e., Kurzweil and deGray)….The Future Squatters who have come to dominate contemporary cryonics are not merely parasites content to sit and wait until robots show up at their doors with immortality on a silver platter, all too often they are actively contemptuous and dismissive of the (fewer and fewer) people working hard to build a practical, sustainable and robust cryonics that withstand the tests of time and deliver its patients to a future they have created; a future not only technologically capable of restoring them to life; but morally and financially impelled to do so, as well.

If one rejects both cryonics-as-medicine and the futurist / transhumanist vehicle to communicate the idea of cryonics, one wonders what the correct approach should be. The observation that “the core problem in cryonics is the absence of a philosophical and moral basis for cryonics and the accompanying ethics and dogma required to enforce it” does not seem to follow from the preceding observations.  Most importantly, what is this “philosophical and moral basis for cryonics” that is required, and why is it separate and different from the general moral conduct that social interaction and reason generate?

It is becoming clearer and clearer that demonstrating the technological feasibility of cryonics is not sufficient for the acceptance of cryonics. There seems to be a growing consensus that “fear of the future” and lack of closure are among the biggest hurdles for giving the idea a charitable hearing.  But little thought is being given to this topic, and it is quite correct that this omission can be squarely attributed to a kind of simplistic futurism that is circulating in cryonics circles. If  even most self-identified transhumanists cannot bring themselves to make cryonics arrangements, why would one expect the rest of the population to embrace the idea?

Cryonics advocates often seem to believe that if they refute the common scientific and technical objections to cryonics (which is not that hard to do because the psychological resistance to the idea prevents critics of checking even the most basic facts about the rationale and practice of cryonics) the social and psychological reservations will take care of themselves. This is not just incorrect, such reservations are often the most fundamental.

One would be surprised if an invasive, experimental medical procedure would lack detailed information about post-procedure care, responsibilities of  the hospital and family members, and reintegration. Considering that for many people cryonics constitutes a solitary leap into an unknown and far-away future, is it reasonable that providers of such care, and advocates of cryonics, think about doing a better job of responding to these concerns. This is mostly unexplored territory because even the most alienating events in human life as we know it cannot capture this aspect of cryonics.  It is doubtful that such concerns can be removed by altering the philosophical and moral basis of cryonics.

 

Meta-research and medical skepticism

The Atlantic features an important article about “meta-researcher” Athina Tatsioni, who has published a number of influential papers about the quality of biomedical research:

He and his team have shown, again and again, and in many different ways, that much of what biomedical researchers conclude in published studies—conclusions that doctors keep in mind when they prescribe antibiotics or blood-pressure medication, or when they advise us to consume more fiber or less meat, or when they recommend surgery for heart disease or back pain—is misleading, exaggerated, and often flat-out wrong. He charges that as much as 90 percent of the published medical information that doctors rely on is flawed. His work has been widely accepted by the medical community; it has been published in the field’s top journals, where it is heavily cited; and he is a big draw at conferences…

He chose to publish one paper, fittingly, in the online journal PLoS Medicine, which is committed to running any methodologically sound article without regard to how “interesting” the results may be. In the paper, Ioannidis laid out a detailed mathematical proof that, assuming modest levels of researcher bias, typically imperfect research techniques, and the well-known tendency to focus on exciting rather than highly plausible theories, researchers will come up with wrong findings most of the time. Simply put, if you’re attracted to ideas that have a good chance of being wrong, and if you’re motivated to prove them right, and if you have a little wiggle room in how you assemble the evidence, you’ll probably succeed in proving wrong theories right.

This raises a number of important issues from a life extension perspective. For starters, these findings reinforce that it is just not credible for mainstream researchers and medical professionals to sustain these arrogant attitudes towards serious research efforts in life extension and cryonics. Good research is hard to do, and there is little of it.  This applies particularly to research that translates into meaningful medical benefits.  It  may be hard to swallow that a lot of  what constitutes conventional medicine is based on flawed studies and interest-driven research, but there is no escaping this conclusion.

Having a strong interest in the results is a double-edged sword. On the one hand, it makes one more susceptible to bias and cherry-picking. On the other hand, it can produce a determined mindset to tackle ambitious research goals (rejuvenation, vitrification). For example, the breakthroughs in vitrification technology at a company like 21st Century Medicine would have been unthinkable if the principal researchers would not have had an enduring strong personal interest in the technologies they are researching. This phenomenon can  also throw some light on the observation that often committed amateurs have more knowledge than professional researchers. Academic researchers often move from one (grant-funded) fad to another without obtaining a wide and deep understanding of the fields they are investigating. Unfortunately, such fashionable researchers are often featured in the media as “experts.”

Athina Tatsioni’s findings should also have a sobering effect on those who think we are in a period of accelerating medical progress. Even the  more credible medical research often fails to contribute to the expected clinical breakthroughs. To those familiar with the complex biochemistry of life, and the opportunity to introduce (long term) side-effects along with beneficial interventions (including attempts to just “repair” something), this should not be a surprise.

Naturally, Athina Tatsioni does not have a high opinion on research that claims benefits for vitamins and supplements:

For starters, he explains, the odds are that in any large database of many nutritional and health factors, there will be a few apparent connections that are in fact merely flukes, not real health effects—it’s a bit like combing through long, random strings of letters and claiming there’s an important message in any words that happen to turn up. But even if a study managed to highlight a genuine health connection to some nutrient, you’re unlikely to benefit much from taking more of it, because we consume thousands of nutrients that act together as a sort of network, and changing intake of just one of them is bound to cause ripples throughout the network that are far too complex for these studies to detect, and that may be as likely to harm you as help you. Even if changing that one factor does bring on the claimed improvement, there’s still a good chance that it won’t do you much good in the long run, because these studies rarely go on long enough to track the decades-long course of disease and ultimately death.

The take-home message is that skepticism is a useful disposition when looking at all research, medical practice, and triumphant claims about accelerating technological progress. One advantage of those who have made cryonics arrangements have is that they have time and, in theory (!), should be less prone to wishful thinking and jumping on the latest bandwagon. As Michael Anissimov writes, “When I talk to older transhumanists that are into cryonics, I see people who are psychologically calmer than those who endlessly obsess over their food, questionable supplements, and other minutiae that will mean jack squat if they get into a simple car accident.” It also reinforces the approach of arguing in favor of cryonics using skeptical arguments (about our arbitrary and evolving concepts of death)  instead of making bold claims about existing and future science.

Further reading: John P. A. Ioannidis – Why Most Published Research Findings Are False.

Mark Plus on cryonics and double standards

One of the mysterious things about cryonics is that some of the arguments that are invoked against it would be considered ridiculous, or even insensitive, if they would be raised in the context of other live-saving technologies. As Alcor member Mark Plus writes:

Why do we call engineering efforts to solve a hard problem which haven’t worked so far “failures,” while some people call cryonics’ attempts at intervening into the death process “denial”?

The difference seems to involve a double standard. We don’t call other efforts to save human life “denial” when they don’t work in some cases, and not just in a medical context. The effort to rescue those trapped miners in Chile may not work, for example; but nobody I know of calls the rescue project “denial,” wants to stop it as a waste of resources, and admonishes the doomed miners to “Get over yourselves,” as one of Ted Williams’s relatives has said to cryonicists.

The same goes for medicine in general. How would we react if authority figures scolded us for seeking health care for serious illnesses or injuries, saying that we should instead deal with our “denial” and “fear of death” issues through, say, strength of character, rather than trying to stay alive and functional through modern medicine? Even opponents of recent political efforts to “reform” American health care haven’t gone that far, to the best of my knowledge.

Read his complete post here.

Thought experiments as knowledge

One of the most remarkable aspects about the ongoing debates concerning the technical feasibility of mind uploading is the excessive confidence that some people have that these issues can be resolved without further experimental validation. The (implicit) assumption seems to be that our current understanding of the neuroscience of consciousness is sufficient to demonstrate the technical feasibility of mind uploading by logical deduction from these findings alone. This is a mysterious claim for at least two reasons. The most fundamental reason is that the scientific study of consciousness has not nearly evolved to a stage that allows for making bold claims about the subject, let alone its far-reaching consequences. The other reason is that, in the absence of empirical examples of substrate-independent life in general, it cannot be argued that such logical arguments are just innocent or inescapable conclusions from what we already do know.

It should not be surprising that such arguments fail to convince some of the participants in the debate. After all, many “mind uploaders” also believe that the case for cryonics is just a straightforward exercise of Pascal’s Wager and the technical feasibility of molecular nanotechnology can be settled by arguing that the idea does not “contradict the laws of physics.” As I have argued in a more detailed article about this tendency, the common denominator in all of  this is the excessive role that is assigned to logical arguments (or rationalism). But there is an important difference between, let’s say, predicting the unmeasured viscosity of a specific aqueous solution from a formula that has been derived from numerous measurements on the one hand and drawing far-reaching conclusions from general scientific observations or even philosophical premises (materialism, reductionism) on the other hand.  This does not mean that one should completely refrain from speculation about future technologies, but it should induce a habit of having less confidence in your conclusions as the chain of assumptions and logical arguments lengthens, let alone if your conclusions are highly controversial.

One could object that since advocates of mind uploading are generally strong advocates of cryonics, that even treating their arguments with skepticism risks alienating prospective supporters of cryonics. The fact of the matter is, however, that presenting cryonics as just one element in a larger futurist framework strongly weakens the point that cryonics is an experimental medical procedure, not an ideology or life-style. It is not possible to present cryonics in a fashion that does not alienate anyone at all. But presenting cryonics as an experimental medical procedure without additional ideological, philosophical, or sociological add-ons  has the important merit of reducing this amount of alienation to the greatest possible degree. It also has the distinct advantage that it facilitates the recruitment of people who can move the field forward; experimental scientists and medical professionals.

Mind uploading, falsifiability and cryonics

On the cryonics discussion list Cryonet cryobiologist Brian Wowk weighed in on the topic of mind uploading in a post that merits quoting in its entirety:

I read with interest Bob Ettinger’s recent remarks about Mark Gubrud’s piece in The New Atlantis.

http://futurisms.thenewatlantis.com/2010/06/why-transhumanism-wont-work.html

Although I have not been around as long Bob, I have nevertheless observed arguments about uploading, identity duplication, and related subjects for decades.  In all that time there are two things I’ve never seen: (a) A truly new argument, and (b) Someone change their mind.  What is seen are people who passionately believe they are correct, and who believe that they have just the argument to finally convince the other side that they are right.  They never do.

I have come to believe that the question of whether a computationally equivalent duplicate of a human mind (assuming equivalence in this context is even definable) constitutes a continuation of the original person may be objectively unanswerable.  It’s almost a matter of taste, like alternative interpretations of quantum mechanics that assume different underlying realities that give exactly the same measurable results.

Eventually the distant day will come when the computational processes of a human brain are duplicated in an electronic computer, or even in another identical organic substrate.  When that day comes, we can be certain of this: If the person who was “duplicated” believed before duplication that duplication constitutes survival of the self, then, by definition, the duplicated entity will insist vociferously that indeed they did survive.  This has ethical implications.  Conversely,
an entity derived from a person who did not believe in this form of survival might be quite unhappy to be told that they were the product of a destructive scan of somebody.  This too has ethical implications.

Philosophical truth aside, evolution selects against humans who spend time worrying about whether sleep, anesthesia, or biostasis endangers personal identity.  Similarly, it is easy to predict which side of the uploading and duplication debates will win in the long term.  There is no entity more invulnerable or fecund than one that believes it consists of information.

Recent discussions of the topic of mind uploading on the Cryonics Institute members mailing-list contradict Wowk’s claim about people changing their mind about mind uploading. Robert Ettinger posted an itemized list with objections against the idea of mind uploading as a strategy for personal survival and I weighed in on the (current) lack of experimental evidence to settle the matter. The effect was that some people changed their mind or became more agnostic about mind uploading.

Wowk may be correct that the question whether a “computationally equivalent duplicate of a human mind…constitutes a continuation of the original person may be objectively unanswerable.” The discussion about mind uploading and persistence of the original person has distinct similarities with discussions about solipsism, consciousness, and the existence of the external world. It is not inconceivable that in a world where mind uploading has become routine the debates will still continue because the hard problem of persistence of the person is not falsifiable in a meaningful manner.

There are mind uploaders and there are Mind Uploaders. The Mind Uploaders are a small but vocal minority who display little patience for the argument that the technical feasibility of mind uploading requires empirical verification and cannot be completely settled by logical deduction or thought experiments. As cryonics activist and ex-Alcor Board member David Pizer says, “Having existed with Uploading Lovers for many years now, I believe they are as firmly entrenched in their beliefs as  traditional religious persons believe that their souls are going to Heaven after death here on Earth.”

Cryonics is often associated with ideas like mind uploading and transhumanism. One negative consequence of this (un)intentional association is that some people who are considering cryonics feel that they have to embrace a much larger set of controversial ideas than what they are actually being asked to consider. As a result, there is a real risk that people reject cryonics for reasons that have little to do with the proposal of cryonics itself. Advocates of cryonics do not do themselves a favor by promoting the idea of human cryopreservation as part of a larger set of futurist ideas instead of just promoting cryonics as an experimental medical procedure to extend life. There is too much at stake to alienate people by piling more controversial ideas on top of what is already considered to be a radical idea. Such a low-key attitude will also produce a more consistent message because it extends the element of uncertainty that is inherent in cryonics to other areas of life as well.


Ken Hayworth on straight freezing in cryonics

Ken Hayworth’s idea of promoting a fixation-based alternative to brain cryopreservation is something I am highly sympathetic to overall, and I hope some progress in this direction results from the work he is doing and trying to induce others to do. That said, I wanted to comment on Hayworth’s remarks about straight freezing of brain tissue.

Figure 1B shows the horrific damage (destroyed cells) that occurs when such a slice is “preserved” using a freezing technique typical of those employed early in cryonics. Such damage is clearly irreversible by any future technology and it should come as no surprise that such techniques were flatly rejected by the scientific and medical community.

While it’s true that straight-frozen tissue as shown looks pretty awful I think it’s too strong a statement to say that “such damage is clearly irreversible by any future technology” unless you have further supporting arguments. To invoke a relevant analogy, we could run a phone book through a garden-variety shredder found in many offices, and still be able to reconstruct it from the resulting debris. The fact that there is debris remaining with the frozen tissue (as opposed to the cases of decay or burning) means we cannot, without further argument, rule out some sort of reconstructive process using future technology, including nanotechnology. It is also worth noting that with imperfect chemical fixation you run a risk of tissue loss over time that does not occur with cryopreservation; even debris resulting from straight freezing will remain as-is so long as cryogenic temperatures are maintained.

I also note that Hayworth says his proposed plastination could only be done properly if you start with a living patient with still-beating heart to distribute the initial fixative.

It is important to understand that the standard fixation and plasticization protocol is started while the animal is still alive. If the animal’s heart is allowed to stop for even a few minutes before the glutaraldehyde is perfused into the vasculature, then the quality of the preservation is markedly reduced. This fact will also be true for any whole brain protocol based on perfusion.

This of course would be problematic for any procedure to be used on humans; you’d have to treat it as some form of euthanasia.