Saturday, January 22, 2011

In Response to Mike Darwin's "Automated Data Collection" Post (Cryonet #33255)

It is absurd for Mike Darwin to maintain that cardiovascular perfusion is “very simple to automated compared to some of the unbelievable complex and exactly manufacturing processes (he’s) seen automated it can be surprisingly difficult, even if you have you have experts, and enormous computing power at your disposal.” [sic] (*Note: Mr. Darwin refers to cardiovascular perfusion as “cardiovascular bypass,” terminology that might be confusing to some, as indicated by Perry Metzger’s Cryonet response to Mr. Darwin, in which Mr. Metzger asks if Mr. Darwin is referring to automating an entire cardiovascular surgical procedure. (Cryonet message 33257))

It’s nonsensical to assert that something “very simple” is at the same time “surprising difficult,” even in the hands of experts with unlimited technological resources. Even more than that, it is preposterous to compare the manufacturing of a specified component, or device, which requires the same, precise, repetitive steps, time-after-time-after-time, to the perfusion of human beings.

Responding to Mr. Darwin’s automated airplane/perfusion analogy, it doesn’t matter WHY the wind blows, or WHY the terrain rises, it only matters that the plane must maintain its center of gravity and stay above the terrain. However, it DOES matter why venous return to a heart-lung (perfusion) machine diminishes. Did the patient’s blood vessels dilate, resulting in more volume remaining in the patient, and less returning to the machine? If so, the proper response might be administering vasoconstrictors. Is the surgeon pulling the heart over, so that he can work on the posterior side, temporarily interfering with the venous return to the machine? If so, the proper response is to temporarily adjust the flow rate, provided that doing so does not result in the patient being inadequately perfused. Has something happened, which resulted in an unexpected loss of blood, from the patient, or perfusion circuit? If so, that situation needs to be recognized and corrected, immediately, and volume must be added to the system, to replace that which has been lost. (This discussion is simplified, and intended to be for an audience of laymen. There are many factors, in regard to both the causes of, and the responses to, such a situation.) If the returning volume is suddenly depleted, does the computer have discussions with the anesthetist and the surgeon, to determine the cause of, (and, therefore, the proper response to), such a situation? This is only one example of MANY issues, which perfusionists must respond to, on a case-by-case basis; a situation that precludes the use of fully-automated perfusion systems. There is nothing in the perfusion process, similar to the precise manufacturing of components, or devices, no matter how complex that manufacturing might be!

Perfusion IS automated, to a large degree. Perfusionists can program their machines to respond to various parameters, in a variety of ways. For example, the machines can be made to automatically adjust flow rates, in response to pressure; or to turn off a pump and clamp the patient lines, in the event of inappropriate pressures, or air in the lines. But, what happens after that? Someone, who knows how to assess the situation, and produce the proper response, must be operating that machine. I find it quite arrogant, for Mr. Darwin to claim he has tried to automate perfusion systems and has found it difficult. Does Mr. Darwin think he compares to the scientists, perfusionists and engineers, involved in equipment development, with the major manufacturers of perfusion equipment? While I’m sure Mr. Darwin has toyed with primitive perfusion equipment, at cryonics facilities, he is not a perfusionist, or an engineer, and he certainly does not have resources comparable to those of companies, which specialize in perfusion equipment, such as those mentioned here:

Mr. Darwin wants to argue that such automation could require less-skilled personnel, something I find disturbing. Someone who does not routinely assemble and operate perfusion equipment is very unlikely to be able to assess, and correct, problems that might occur with an automated-system failure. Would Mr. Darwin like someone who has memorized the contents of a dozen aviation textbooks, but never flown an airplane, to be sitting in the cockpit of his commercial airliner, when the computer goes out? I find his argument for “knowledge without reflexes” being “sufficient,” (in regard to cardiovascular perfusion and flight), to be absolutely ludicrous.

Mr. Darwin’s remarks about a market not existing, for automated perfusion, resulting in “no economies of scale…that further drives up the price and drives down the reliability of any system you do develop,” is just as ridiculous as most of his other observations and speculations. The perfusion disposables I used two decades ago, cost approximately $1,600; today, the same disposables are around $500. I’m not a financial expert, but the machines, themselves, seem not to have increased more than that due to ordinary inflation. If there has been an increase, it has probably been due to the developments in the computerization/automation features! Salaries also seem not to have risen, other than increases due to inflation, over time. Never before has perfusion been so technologically-advanced, reasonably-priced, or safe. It is much more likely that heart surgery will eventually be performed, without the use of perfusion, than with the use of fully-automated perfusion, as evidenced by an ever-increasing number of “off-pump” procedures. (Of course, this has nothing to do with cryonics. Heart surgery can sometimes be performed, without the use of perfusion, but the vitrification of human bodies cannot.)

The fact that Mike Darwin is one of cryonics’ greatest “superstars” should be quite telling. How many cryonics projects have been directed, on the advice of Mr. Darwin and others like him? How many of those projects were based in ignorance of existing equipment and technology? For so long as people like Mr. Darwin and his peers are considered to be “experts,” in cryonics experiments, there is likely to be nothing more than ample misdirection and false promises. It seems a very small group of self-interested people have made, what could be an interesting scientific experiment, a total sham. (By “self-interested,” I do not mean people who are interested in extending their own lives; I mean people who are primarily interested in maintaining their over-inflated egos and/or bank accounts, by maintaining control of experiments and/or projects, which they are not capable of leading.)

The fact that the same small group of people have remained in control of the cryonics industry, for so many years, while the quality of their services have often been misrepresented, is why cryonics activities should be regulated. These organizations simply cannot be allowed to charge up to $200,000+, for their procedures, or to encourage people to name their organizations as the beneficiaries of trust funds and/or bequests, unless they are willing to fully, and prominently, disclose their capabilities, (or lack thereof), in their marketing efforts. I don't mind "garage projects," but they should be advertised as such.