Throughout much of our history, cryonics has been vulnerable and lacked stability due, in part, to limited options when potential cryonicists are looking for providers of cryonics services.  In turn, the few cryonics providers have had limited options when they were looking to hire individuals or to contract with companies to provide the specialized services that cryonics companies need. 

There have been attempts to alleviate this problem by inserting capitalism into cryonics by splitting off parts of the cryonics process into such private companies as BioPreservation, BioTransport, Kryos, etc.  None of these attempts have been particularly successful so far.  A common theme exists between these attempts and similar challenges others have had to face over the years -- a lack of fulltime medical professionals interested in being part of cryonics and committed to providing the best care possible.  This lack has resulted in the inevitable over-reliance on key individuals.  On several occasions, losing the one or two most knowledgeable and committed individuals has compromised the ability of organizations to stay in business and remain effective.  If cryonics companies had the positive reputation and the financial ability to hire and replace full-time medical staff as easily as a hospital does, the challenge would be reduced, of course. 

One way we can reduce the risk of being overly reliant on key individuals is to diversify the special knowledge and abilities available to us by means of "outsourcing."  By this, I do not mean creating new companies that specialize in an area of our business (and which are at least as likely to fail as other new businesses).  Instead we need to build relationships with existing corporations that have established track records of success outside of cryonics.  Long-term, we may need to work toward a full merger of cryonics with the medical establishment.

Current outsourcing

There are parts of this business which have, to a varying degree, already been outsourced such as the production of patient Dewars, neuro cans, whole body pods, utilization of an emergency answering service, use of contract medical professionals, etc.  Given enough time, one might expect the outsourcing of cryonics would naturally occur on its own where it is reasonable to do so, but I think it would be a great benefit for us to accelerate that process now.

Lessons learned and lost

There are plenty of challenges associated with trying to professionalize cryonics.  One is simply that of developing continuity of personnel.  During my ten years of being paid to do cryonics, I have gotten a new supervisor every six to twelve months and the process of watching people learn old lessons begins again.

As a relatively benign example, in the early days of cryonics the primary means of gaining access to medications was the equivalent of dumpster diving.  Cryonics companies arranged with medical facilities and medical supply companies to donate their expired and expiring medications for "research."  Early cryonics companies didn't have much money, and many manufacturers and suppliers were suspicious of cryonics and refused to sell medication directly to them.  Even though a medication may have officially expired, that does not mean it is necessarily bad and could not be used successfully on a patient.  For example, heparin is a clear solution and one way to know that it is appropriate to dispose of it is when it turns yellow; as long as it remains clear, it is still considered good.  Since the medications were to be used on what were legally "dead bodies," there were no legal implications. 

The consequence is that one administration from the next changes the official position on what is permissible -- even though cryonics companies can now buy new medications off-the-shelf or minimize costs by using what they have in stock before ordering more.  This cycling of policy has sometimes resulted in the use on actual cryonics patients of medications that were much further beyond their official expiration date than would have been necessary with proper rotation.  As a result, I learned early on that expired medications which were being relocated to training supplies -- where the expiration dates stood out -- instead should be conveniently and quietly relocated to the trash without discussion.

This slow learning curve does not necessarily apply to everyone who has come and gone over the years, but the degree of turnover is unhealthy in my view.   There have been those who have had good credentials and healthy commitment to high standards; but often they end up running for the door or being pushed out by the amateurs who are determined to stay.  Part of the challenge is that those who uphold high standards want to fix everything and are inclined to burn themselves out.   Also, the more amateur cryonics employees may end up working against the professionalism of a new employee, perhaps because the skills that the professional brings to the job -- skills that may be necessary to meet higher, medical standards in cryonics -- may exceed the abilities or the commitment of the employees already in place.

Naturally, professionals seek competitive pay; but they also look for job satisfaction and want to make a positive contribution to our field.  They want to be able to practice their skills regularly and work in a professional environment.  They want their knowledge and experience to be valued and appreciated by both management and co-workers.  If we cannot provide this kind of work environment, it will be difficult to retain professional medical and science employees in cryonics, and we cannot expect the improvement in quality of service delivered to our patients that professionals could bring.

Fear of professionals  

This difference between the standards expected by medical professionals and the standards promoted by cryonics amateurs may result in the amateurs appearing to be intimidated by the professionals.  If a cryonics company hires a medical professional who expects and attempts to implement higher standards of cleanliness, accuracy, performance, etc., the older, more amateur employees of the company, including managers, can feel that their previous work is being demeaned or insulted.  For many people, these new perspectives and demands for improvements can be hard medicine to swallow.  The too frequent human reaction is to belittle the improvements as unnecessary, insulting the person who suggested the improvements.  The result is the continued dumbing down of cryonics procedures, keeping the procedures simple enough for lightly experienced amateurs, and a focus on maintaining the status quo.  Often it seems like the best way for the cryonics leaders to avoid this conflict is to make sure they hire new employees less capable than themselves.  While that avoids conflict, it does nothing to improve the results for our patients.

One excuse that has been used to avoid hiring professionals is that they often bring with them medical attitudes and habits that are opposed to what we are trying to accomplish in cryonics.  Sometimes pros need to unlearn a few habits in support of cryonics, but they are often a quicker study than those who are untrained in medicine and lack relevant experiences.  We can have problems with any employees.  This is not a reason to avoid hiring professionals.

This fear is also related to the suspicion of outsourcing.  Outsourcing aspects of our business in the same way hospitals do also gets medical and technical professionals involved, who have higher standards of quality than most of the employees in cryonics are capable of upholding.  This can threaten cryonics employees.  Equally important may be the fact that cryonicists and the other people in work in this field tend to be people who want a lot of individual control, and outsourcing tends to lessen that control.

Related to this are the cryonics employees' potential loss of status by losing duties that are the basis for maintaining one’s position in the business, and perhaps even the perception that improved quality and professionalism could threaten the less trained employees with the loss of their jobs.  Ironically for cryonicists, simple fear of change probably plays into this perception, as well. 

However, cryonics employees who are ready to adapt, as must employees in rapidly changing industries all over America today, should have little to fear.   There is an extremely long list of issues that need to be resolved before we can think about reviving any given patient, even under the best of circumstances using the latest protocols today.  Until cryonics is no longer necessary and all those who can be revived are revived, our mission is not complete and there is work to be done.  As long as we are committed to this field and are willing to exchange old responsibilities for new ones, there is ample room for continued employment.  There is perhaps a greater risk of job loss by refusal to change in cryonics, making the entire field eventually seem less relevant and less capable of fulfilling its promises.

Outsourcing Myself

From a personal perspective, if there is anyone exposing themselves to a loss of traditional duties within the industry, it’s me.  The areas I have looked into spinning off are the ones that I’m most familiar with and on which I have based my employment.  You might think that an attempt on my part to outsource my area of experience is equivalent to a soldier giving their location for bombardment when the enemy is on top of them.  However, cryonics is in such deep need for a revolution in the quality of care provided, that I think that is what is required.  I have enough confidence in my knowledge of the needs of cryonics that I can be part of the "integration team" and then eventually find new areas in cryonics to work on. 

The real enemy in our business has been a self-imposed monopolistic institution that is influenced by individual monopolies, due in part to limited membership growth and our lack of integration within the medical industry.  As a consequence, it is my belief that our business model has been largely stagnant over the past forty years compared to what could have been if we had chosen a true medical model.

Giving away one’s leverage so there is no leverage

One way we can break this inadequate business model is to give today's knowledge away freely and to allow individual technical tasks to take on a life of their own, similar to when the communications industry was broken up.  By outsourcing my own knowledge base and making my traditional position vulnerable in cryonics in the short-term, I believe this will ultimately stimulate the creation of more jobs with companies that operate in a professional manner and result in a better end product for our use. 

The downside from the perspective of some might be that amateurs entering this field in the future would only be given jobs in accordance with their actual educations and skills.  We would no longer be creating surgical assistants out of librarians, computer programmers, and real estate managers.  But if you look at cryonics from the point of view of "you as prospective suspension patient," this is a very good change.  And if you are serious about cryonics, what other point of view is valid?

Eventually, decisions on medical and technical questions will be assigned to those who are duly qualified.  Those who have little or no understanding of medicine will no longer be allowed to make the most important medical decisions of our patients' (and our own) lives.  This last point cannot be overemphasized, because in today's cryonics organizations the final decision on what is best for any given patient can easily rest with someone who not only has no formal medical background, but who may have little practical experience in cryonics.

Self-imposed limits on vendor communication

A problem in the past has been how to communicate with vendors about what cryonicists do and why we need their products.  There have been at least two conflicting approaches within cryonics.  One is between people who think that we need to carefully follow all federal regulations and limitations, sensible or not, and those who have a sort of “ultra-libertarian” approach that says we should do whatever we think is useful whenever we want, as long as we think it is good for the patient and for cryonics.  In the short run, this second approach might make us feel good about our independence; but such defiance serves to alienate the professionals we need to reach our ultimate goals, especially since we often cannot know if those decisions really were better for the patient.  We do more to gain the respect and support of professionals when we take the time to learn rules and regulations and demonstrate how we are making progress in those directions.  In my experience, when we have been willing to do what it takes to get the job done right, we have gained a payoff in having major corporations not only signing on to help us with our business needs, but even changing their corporate policy to make the relationship possible.

The second vendor communication conflict has been that between those cryonics leaders who feel we should hide everything and tell very little and those who feel that we really need to be more open with vendors.  Then we can choose to do business with those who are willing to work with us.

Early on in my career, I was warned to be careful when dealing with vendors not to divulge what it is we do out of fear they would refuse to do business with us.  This restrictive attitude was probably necessary in some cases when cryonics was less well known.  One of the experiences that led to this attitude was the failed relationship between cryonics and the main manufacturer of cryonics whole-body Dewars in the 1970s.  The small company was purchased by a larger group that was unhappy when they discovered what these containers were being used for.  They refused to build any more cryonics-specific Dewars, leaving Alcor and other companies scrambling for another source.

For quite a while, even telling other companies or vendors that we were doing cryonics was viewed by some as act of sin.  Therefore, my first position when I started working in this field was to be extremely conservative when approaching other companies or vendors.  But times are changing, and there is value in testing the waters to see how far one can go, so we have learned there is ample room to push our business model to new frontiers.

Dealing with vendors today

Today, it is a little easier to educate vendors by letting them know that interest and research in the field of cryonics has resulted in blood plasma expanders that are helping to save the lives of wounded soldiers in the field in Iraq or the average person on the street.  One of the things I mention when speaking with new manufacturers' reps is that science is looking into the possibility of re-growing new limbs and organs.  I ask them to imagine an amputee who has lost an arm and then imagine how we will someday use science to trick the genes at the end of the stump to think it is in fetal development and regrow a new arm.

Another future possibility that I mention to them is that one day they may go into their doctor’s office and provide a DNA sample.  Then the doctor's team turns around and grows them a new heart, liver, kidney, etc.  Research is going on now in support of growing specialized cells in vats and then "printing" them one layer at a time to build new organs.  One day these organs might be cryobanked for emergency use if or when there is a need for those individuals to receive an overhaul of primary organs.  I note the possibility of one day regenerating their own organs; but maybe an even better approach might be to engineer something better and swap out aged and worn organs for superior, enhanced organs that would work better and last longer.  Those organs could even be stress-tested in advance of cryobanking to certify their ability to function and to self-repair under challenging circumstances.

Biotechnology research is moving so rapidly today that a surprising number of the manufacturers' reps do not perceive this talk as science fiction.  For us, cryonics is not science fiction, of course; it is more similar to hanging out in the Wright Brother’s garage before the invention of flight without knowing whether or not it will work.  The average rep out there now makes this connection.  On numerous occasions I’ve heard from them that they see us as modern day pioneers out on a new frontier.

I note that even though these people may not have any personal interest in cryonics itself, they are curious about the science and technology.  They understand that developments in these fields may be part of the progress that improves their own health and the quality of their lives someday and they want to know more.

As a result, we have a lot more leverage today then when I first started --enough to be able to exert some pressure when dealing with larger corporations.  The advantage with dealing with a larger corporation is that if you are not getting satisfaction with a local Rep, you can contact the regional manger for information.  The way to approach it diplomatically is to tell them that the Rep must be busy and you need the information to get approval for making a purchase or to generate a report that might result in you making a purchase.  This process is different with small businesses, which may not have management levels you can use.  However, smaller businesses can be eager for new business and may be more flexible entrepreneurs.  If not, you move on down the road to one of their competitors. 

Whether they realize it or not, the company that adapts to new business opportunities is more likely to survive over the long run, unlike businesses of the past who felt it was important to continue to make horse and buggy whips at the peak of their market.  Those who get this venturous perspective are more inclined to work with companies with unique needs, either because they are betting that new opportunities can help ensure their long-term survival or because that kind of attitude comes from people who are excited about new and interesting angles for their business.  I’ve heard both from small businesses and international corporations that cryonics seems like a pioneering field and that the idea of being on the cutting edge appeals to them. 

One of the things I’ve come to appreciate over the years in working with vendors is that their motivations are about the same as everyone else's.  They have a job that may or may not interest them and then they go home to their personal lives.  Strong companies can have poor sales reps; weak companies can have highly motivated reps. Some reps are more interested in their customers in general than other reps; some may become more personally interested in what our company is doing.  Sometimes you can overcome a poor rep by talking with superiors; sometimes the only solution is to wait until the inevitable personnel turnover occurs.  But often the best approach is simply to be professional and organized yourself, to show them how you can both get to "yes" in a manner that makes their lives easier. 

Remember, our goals are more long-term that those of a sales rep.  We can stay committed to what we are trying to accomplish and continue to look for a manufacture or a sales rep who will provide what we need.  Most reps simply want to make a sale with the least hassle possible before and after the sale, so they can move on to the next one.  Generally, selling to us is simpler and more straightforward (assuming we help make it so) than arguing with us about cryonics, so even sales reps who are not interested in our ideas are likely to take the easy path and make the sale.

Outsourcing results in higher quality, medically certified products

In the near-term, outsourcing will result in higher quality products for our use.  For example, the tubing pack used for heart bypass surgery at your local hospital may have also been made by the same corporation willing to provide washout and cryoprotection tubing packs for cryonics.  That corporation can produce these packs under medically certified standards, which no cryonics provider can currently offer.  By working with established professional companies that specialize in tubing packs, we could have the added advantage of using heparin-coated products in re-circulating the blood prior to washout when quick access is possible.   Heparin-coated tubing helps mitigate the blood's negative response to having foreign objects inserted into the blood stream.

The manufacturer can only assemble heparin-coated tubing packs as a complete sterile tubing pack.  The heparin coating itself is a complex nine-step process.  If we attempt to assemble and re-sterilize the heparin-coated products, the re-sterilization damages the heparin coating. 

Since our field is currently providing for a blood washout prior to recirculation, it is possible that we don't need heparin-coated tubing, because we have already eliminated the blood.  There maybe scenarios that would make this product valuable to us, but the details are not important in this chapter.  This is an example to show that working with professional companies to obtain tubing packs and other supplies gains us access to many improvements that we could not otherwise discover or obtain for ourselves.

Dealing with inaccurate production of outsourced tubing packs

A valid concern that has been expressed about outsourcing tubing pack production is our inability to verify the accuracy of the assembly, since the packs are delivered in opaque protective covers.  But accuracy is not only a concern for outsourcing; it is also true for in-house production.  Based on my experience over the past decade, errors do occasionally slip through even after in-house tubing packs have been verified prior to sterilization.  If the washout personnel are familiar with tubing pack construction, these errors can generally be fixed during the preparation for washout.  Still, we really want the opportunity to examine the assembly before we open it up, if possible.

Fortunately, the issue of being able to verify the accuracy of tubing packs has been resolved by replacing tubing covers with .2 micron gas filters.  In the past, tubing covers were used to help keep dust and bugs out, but were vented to allow the expansion and contraction of air and to allow ethylene oxide to enter for sterilization.  The downside was that a small amount of dust or particulates and biological contaminates could pass through the covers if they were not properly maintained in a sterile package.  Also, the tubing covers had a tendency to excrete oil from the plastic, becoming greasy, and adding a possible source of contamination.  By replacing the tubing cover with a .2 micron filter, tubing packs can be inspected after sterilization without internal contamination of the circuit (depending on the design of the circuit in question).  Naturally, the tubing pack should be treated with appropriate care when handled during the inspection process.

I have questioned companies as to whether the tubing packs are properly sterilized while using the .2 micron filters, out of concern that the ethylene oxide molecules might stick to the fibers of the filters; but the manufacturers have had no opinion on this.  Other people in the cryonics field have given their opinions that the molecules are small enough to make such concerns a non-issue on this particular application.  In any case, it seems we have lived with this in the past, since some of the ethylene oxide molecules will settle out and remain within a tubing circuit as a general rule when the filters are not used. 

Dependence on outsourcing and unprofessional insourcing

An issue of concern might be that we would be dependent on an outside supplier to deliver the washout and cryoprotection tubing packs in a timely fashion.  I don't think this is a valid worry.  We are already dependent on the manufacturer to supply us with components, assembled or not.  The only way we can free ourselves completely from outside dependence is by manufacturing all the components ourselves, which is not a realistic expectation.  The key to avoiding being dependent on any one vendor in our supply chain is to have more than one vendor capable of providing the same services. 

Those cryonicists who are fearful of dependence upon professional outsourcing need to understand that they currently have an equal dependence on in-house capability, and this in-house service can provide even fewer guarantees of consistency and quality.  In cryonics today -- and probably for years to come -- there is still a large turnover (or job rotation) of employees and those who manage them.  Knowledge of past procedures, previous failures, and lessons learned can be easily lost or ignored as new employees move into those roles.  And the field of cryonics has not developed either consistent standards or a pool of qualified and trained individuals to provide continuity.

In cryonics today, tubing packs could be produced in any old room and those who assemble them might do so with their bare hands.  One might sterilize a tubing pack, but it does not eliminate the oils and debris that are left behind during the assembly process, which can be easily picked up by the surgeon’s gloves.

The tubing pack manufacturer I have spoken with produces 2,300 different custom tubing packs for hospitals worldwide. They assure me they are accustomed to the need to produce them accurately, to specific standards, and in a timely fashion.  If they did not do so, hospitals would not do business with them.  Hospitals experience a degree of liability exposure well in excess of what cryonics organizations have been exposed to.  If hospitals prefer to have their tubing packs produced by the same vendors who are willing to work with us, then we perhaps we should learn that lesson, too. 

New options such as outsourcing tubing packs do not take away from our capability, but add another tier over what currently exists.  In an emergency, we can still build tubing packs in-house; and that capability should be retained to ensure we could provide service without interruption.  Still, the ideal option is to have them produced under standards that pass FDA regulation, which is not something you will find among any of the current cryonics related service providers.

Outsourcing benefit -- free documentation

With the dynamics of changes to protocol and rotation of employees in cryonics, we do not document our procedures and changes as well as we would like.  To a varying degree, efforts have been made to document the details necessary to maintain good SOP in many cryonics systems.  However, many of these efforts have been half-hearted; and even when the original work was good, documentation of subsequent changes has frequently been overlooked or ignored.  So many critical changes may only be known by a couple of people who perform the tasks.  With outsourcing, including tubing pack production, free documentation is provided as a standard part of the service.  Not only do these professional companies produce clear documentation, they do it much more quickly than we ever have in cryonics.  

The step-by-step process of outsourcing tubing pack production

Because both sides are not typically sitting down together to discuss it, the process of outsourcing tubing packs is not as efficient as I would like it to be.  My first preference would be to build a tubing pack to my specifications, and send it to them to reverse-engineer.  However, I can see that this would not seem efficient from the other company's point of view.  They already have a system of documenting the design and construction of tubing packs in place that works for them.  It turns out that, once we learn to speak the same language, the remainder of the effort required to build what we need is not too hard. 

The process starts out on our end when we produce a legible diagram and send it to the tubing pack company.  The drawing is converted into CAD or similar software, and then they turn around and ship a completed tubing pack from their diagram.  

Once the tubing pack arrives, we are expected to inspect it for errors and write-up a change list and submit it to them.  They follow with a new tubing pack along with an updated diagram.  This process continues until they ship a tubing pack that meets our expectations.  The work up to this point is done free of charge.  There isn’t a catch to this nor is there an obvious profit motive for the construction of tubing packs other than to move product.  As a result of competition in the industry, these tubing packs are shipped out at close to cost.  It appears that much of the benefit to the manufacturer is in keeping business away from their competitors.  This adds another benefit for cryonics in that we piggyback on economies of scale.

The following diagram shows one page of several which was submitted to me by the tubing pack manufacturer, along with a tubing pack.  The diagram is inaccurate, and we didn't proceed with this because we quickly came up with several new ideas, but it gives an example of what is provided for free.  It is definitely superior to hand-scribed diagrams or even those that have been generated with computer software in-house:

Outsourcing other related equipment, example one

Sometimes we need other custom-made products for cryonics, including thermocouples.  We now have established a relationship with a thermocouple manufacturer, and this company has made Type “T” thermocouples that fit into thermo wells.  This thermocouple is compatible with standard perfusion circuit ports that hospitals use, so we can use standard systems instead of trying to invent new ones.  This type of thermocouple also allows for an increase in the accuracy of the reading as a result of metal-to-metal contact with a thermal break, over and above using insulated thermocouples glued down into thermo wells.  Having a thermal break reduces or eliminates the consequence of room temperatures giving a false reading that is warmer than what is being measured as a result of the conductive path of the metal hardware functioning as a heat sink.  For most of our tasks, we are content to have the readings roughly within one degree of accuracy, so the non-grounded thermocouple is a reasonable option.  The accuracy of the reading can be improved with grounding, but then it adds the possible complication of creating a feedback loop when used with computer monitoring systems.  See diagram below that was provided for free.

Outsourcing other related equipment, example two

Also along this theme, a relationship with a biochemical bag manufacturer has been established to provide sterile bags for tubing packs and for the production and storage of washout solutions and cryoprotectants.

The previous generation of bags was purchased from a company that packages milk.  "Milk bags" are vulnerable as a result of the plastic material being thin and relatively easy to puncture, and they have a cap with a nipple for the tubing that can pop off if not properly cared for.  Once the cap is removed and replaced, it becomes highly susceptible to coming off thereafter; and this issue has previously proven to compromise the quality of care provided to patients in the field when trying to ship washout solution.  The utilization of milk bags for the storage and shipment of chemicals in cryonics is unsafe and out-dated technology that all groups should eliminate, if they have not already done so. 

The new biochemical bags are much stronger and do not have a cap that can pop off, resulting in a lower probability of spillage and contamination.  The chemical bags are manufactured in a clean room and shipped ready to go with all the necessary tubing, filters, and clamps in a package that has been sterilized using gamma radiation.  Also, the manufacturer has been willing to increase the size of the bags from 20 to ~28 liters in response to feedback from standby personnel who have requested the additional capacity for a thorough blood washout.  They are willing to make any other size within reason.  (We originally had 30 liters in the bag; but had to reduce the volume because of airline weight restrictions.)  Again, another diagram below was provided free of charge.  All these diagrams were sent prior to us making a purchase:

Chapter 2 will be sufficiently long that my current expectation is to release it in sections once they are ready.

Chapter 2

Field Vitrification

Introduction

As a caveat, this notion results in obvious challenges in making cryonics a true medical procedure and I realize what you read here may seem a bit optimistic at times, but to the extent these things are possible and there is sufficient support for them, could take some time for us to bring to fruition.  There is a fair amount of history here, important motivational lessons along the way, and progress in this direction.