> At this point they will have no blood in their body, no breathing, and no brain activity. They will be clinically dead.
Is this right? That seems to imply that brain activity can be restarted from a cold, "electrically" inactive mass of grey matter. I thought brain dead was dead and there was no coming back from that.
Is the article accurate? If so, does the ability to restart the mind from an inert brain tell us something important about how thought and consciousness works?
Regarding brain death, I think you may be mixing up cause and effect. When the brain's activity ceases due to catastrophic structural damage, that's pretty much the end. But if the brain is simply "paused" without deterioration, I don't see why consciousness couldn't return once blood flow is restored.
(Personally, I'm interested to see if anyone reports any kind of dream-like experience while undergoing the procedure. I know, I know, it's impossible. Still fun to imagine our scientific understanding of the mind being turned upside down.)
But will it be the "same person"? Does cold-starting from the same neural network give you the same consciousness or a copy? Does consciousness require some form of continuity that's lost if you lower neural activity beyond a certain level?
Perhaps I did not phrase this question properly, hence the downvotes. Let me retry:
Consider a situation perhaps 5-10 years from now when this procedure is widespread. A critically wounded person has two treatment options: the best is this procedure followed by repairs. Second best is traditional surgery, which carries some risk. If the person is unconscious and cannot give consent, are we going to treat this as just another procedure? In which case the doctor can make the decision.
I ask because humans tend to identify themselves with an area localized somewhere in the space behind their heads. The do not identify themselves with exact mental replicas of themselves. This has never been a problem in history because such replicas do not occur in nature and we never had the technology to create them. But this procedure may -- I repeat may -- produce a virtual replica of sorts by putting a pause in between brain activity.
Like I said, people have already asked this about cryogenics, but no cryogenically frozen person has ever been reanimated. This procedure, however, is viable.
The same 'consciousness gap' problem already exists in lesser forms: sleep, anesthesia, coma, also, brief periods of 'clinically dead' time as mentioned in the article during massive blood loss or other extreme situation.
Actually, this type of procedure done succesfully would strongly imply that there is something beyond simple neuronal activity that comprises a person's "selfhood".
Dr.Sam Parnia, the resuscitationist mentioned elsewhere in this thread, has some thoughts on this:
It is considerably ironic that after 4 years on HN, the first comment I've ever made that been voted down past -1 (it was at -5) is one that I don't even have any strong feelings or opinions on. Also, I'm not even insinuating there's some kind of religious or spiritual connection here (I'm not religious).
Indeed, I'm only quoting a renown expert in this field, who has been responsible for many of the developments in using cold saline flushes for cardiopulmonary arrest resuscitation.
Clearly, there's a group of people here on HN who have unusually strong emotions in response to any suggestion of phenomena that go beyond current scientific understanding. Not sure why that is, since this is where the most interesting science will take place over the coming centuries.
I had no idea this was a flamewar topic and will assiduously avoid commenting on the issue in the future. It's too bad, since I enjoy thinking about the implications here, and have long had an amateur interest in the brain sciences.
Edit: OK, my post above was upvoted from -5 back to 0. My faith in HN's commitment to fairness and rational discussion is restored. Thank you.
That's a huge stretch. For starters, we know that the brain is extraordinarily good at inventing detail to fill in gaps. A lot of what you think are memories are pure fiction propped up by sufficient real information to pass.
There are many much more likely scenarios to rule out long before there's any reason to consider those ideas, and in most cases there is no reliable way of ruling them out, because there's been insufficient controls in place (unsurprisingly, given that it's not why they are there) - just like a cold reader can extract vast amounts of information from people without them realising, so can normal people with a fascinating story that gets people involved. Anyone that have talked to anyone present in the operating theatre afterwards, for example, can not be considered a reliable source, because lots of information might have been filled in (and such information can easily get recalled as memories by the patient later, without any intent to deceive).
I think both you and the other commenter are assuming I was referring to something religious. I most assuredly was not, nor is Dr. Parnia.
Read the article. The quote from Dr. Parnia that sums up his thoughts:
"All I can say is what I have observed from my work. It seems that when consciousness shuts down in death, psyche, or soul – by which I don't mean ghosts, I mean your individual self – persists for a least those hours before you are resuscitated. From which we might justifiably begin to conclude that the brain is acting as an intermediary to manifest your idea of soul or self but it may not be the source or originator of it… I think that the evidence is beginning to suggest that we should keep open our minds to the possibility that memory, while obviously a scientific entity of some kind – I'm not saying it is magic or anything like that – is not neuronal."
Really, this should be obvious. If a human being emerges alive on the other end of a two-hour period with no neuronal activity, then is simple neuronal activity really what comprises a human's selfhood? I'm not saying it's magic or religion, but at the very least it's interesting to think about.
As someone who has had a neurological illness that impacts my memory, I can assure you that it is neuronal.
All of this 'resumption' of being/existence means is that the same structures that were in place before the intervention persist through the duration of the surgery. Which is exactly the point of interventions like this - to make sure that the brain can resume its normal activity.
If your brain is identical to itself after as it was to before then you will have continuity of subjective experience.
The obvious proof of this is that you go to sleep every night. That is a loss of consciousness, during which you are dormant. In some sense, you don't fully exist when you are asleep. Nonetheless when you wake up in the morning your brain constructs you as you yet again, mostly the same as you were the night before.
Your brain simply remembers how to be you. Your brain remembers how to be perceived by itself as itself. This includes your outward personality but also your inward subjective experience. That is why we have this sensation of continuity from one moment to the next.
But as someone who has had that continuity broken I can assure you that I wish there was some other thing that kept it going, not related to neurons. However, in my experience, it seems like there isn't.
The brain is a phenomena that requires neurons to exist, but simply having neurons doesn't make a brain. It's structural like you've said. The arrangement (and connection) of the neurons is what makes one brain different from another much more so than anything else.
As long as you preserve that structure, you're preserving the "person" as they identify themselves so to speak.
What makes the me that wakes up every single morning after having slept the same me that went to bed every night? From a consciousness perspective, it's the memories. That's the only thing I can really track that make me, me. Boot my brain up sans memories and I'm not really me. With memories I am. At least as far as I can tell.
But if you could pause your brain and make a perfect duplicate, with the same neuronal connections, and then "wake up" both you and your neuronal clone, would you experience yourself as two different entities?
And if you only woke up the clone, would it be you who was experiencing the clone's life? Or a different entity?
Based on the grandparent's logic (which I support), they would both be equally "you", assuming it was a perfect duplicate. From that point forward, the two people would have different experiences, and so would become different people, just as you have different life experience now than you did a week or a year ago, and so think and behave somewhat differently.
That said, I bet they would also have a pretty fascinating relationship: like a twins bond, except much more so. Given their shared brain structure and largely shared life experience (shared to a degree that no two separate people could), their thought patterns would obviously remain very similar. It would probably feel very much like they could read each other's minds.
If your liver starts filtering toxins on the other end of a two-hour period of clinical death with no metabolic activity, then are simple liver cells really what comprises a liver's function?
No, you missed the analogy. The analogy is that a human's essence or "selfhood" is merely the product of a successfully-functioning brain, in much the same way that toxin-processing is the product of a successfully-functioning liver.
No, I got the analogy, but it fails because only one of the two analogy relationships involves the concept of self, which is quantitatively different from a simple physical process (at the very least, it's an extraordinarily complex physical process that exceeds our current understanding).
But this is clearly flamewar material for a lot of you, so this is my last comment on the matter.
We don't understand what it is yet, but more and more data points to what you have in parantheses - that it's an extraordinarily complex physical process. But even its extraordinary complexity is simpler than the other explanation you are offering, which is the possibility of a supernatural entity, for which you have to assert a whole new class of phenomena that somehow interacts with physical phenomena but is also fundamentally different from it. Then you have to go and explain why something that isn't physical can interact causally with something that is.
When a top is not spinning, where is the spin stored?
When it's not raining, where are the rainbows kept?
I think a simpler explanation is that your self/psyche is created by the actions of the brain (or the whole CNS). When the brain is not working, they are not there. When it starts working again, they are back. They were really gone for a while: no need to resort to another vessel for them.
I'm a little mystified by his syllogism here. OK, there is no neuronal activity, but what we measure is electrical, yes? Neurons also store information chemically; and Parnia observes that keeping the brain oxygenated is essential to recovery because brain cells enter apoptosis in the absence of oxygen. I can't help feeling that this is like saying there's no electrical activity in a battery when it's not wired up, therefore the electricity must be coming from somewhere else outside the battery.
Mind, I don't necessarily disagree with his thesis; for reasons of my own I think there's something to his notion of brain-as-antenna. It might be that the writer misunderstood him or omitted some necessary context from the money quote due to a lack of scientific insight. I'll look up his book, which sounds quite interesting.
Who exactly is claiming neuronal activity forms the basis of self-hood? Sure, this might mean long-term memory doesn't need continuous neuronal activity to maintain, but I don't know anyone that thought so in the first place.
I suppose it depends on the idea of what consciousness (in terms of what constitutes the self, rather than state of alertness) is - if one considers it to be just an emergent effect of neuronal activity, then that would fit by definition.
There's nothing in this article or the one you linked to that suggests consciousness is anything but the product of biochemical activity in the brain.
I'm sincerely curious how you think that's the case.
edit: i use 'neuronal' and 'biochemical' interchangeably in this context, because I don't see a sharp distinction. I read the whole article, but I missed the quote you excerpted. I am boggled by it. Systemic death means nothing if neurons don't die (apoptosis) and the brain remains structurally intact - it's structural and chemical properties of neurons that determine self, and if those are preserved then it's fairly shallow notion of death. I mean, what does he say about people that suffer strokes or TBI and are completely changed by it, even though they never were clinically dead? Sorry if I misinterpreted you, but you utilized the passive voice in a way that made it seem like you were strongly implying it.
edit: you may be unaware of the enormous structural complexity of the brain (see purkinje cells) and the fact that sensitivity to input can result in structural changes (synaptic plasticity). It's the graph structure of the billions of neurons and hundreds of trillions of connections combined with the structural changes at those connections that effect their sensitivity to neurotrasmitters - not the series of impulses at any point in time - that encodes self.
>There's nothing in this article or the one you linked to that suggests consciousness is anything but the product of biochemical activity in the brain.
First, both the article and I mentioned "neuronal activity" not "biochemical activity". Second, did you even read the article? Money quote from Dr. Parnia:
"All I can say is what I have observed from my work. It seems that when consciousness shuts down in death, psyche, or soul – by which I don't mean ghosts, I mean your individual self – persists for a least those hours before you are resuscitated. From which we might justifiably begin to conclude that the brain is acting as an intermediary to manifest your idea of soul or self but it may not be the source or originator of it… I think that the evidence is beginning to suggest that we should keep open our minds to the possibility that memory, while obviously a scientific entity of some kind – I'm not saying it is magic or anything like that – is not neuronal.""
>I'm sincerely curious how you think that's the case.
Did I even say I did? I said "if..." and "would strongly suggest". First a conditional and then a qualifier. I personally have no strong opinion on the matter. Clearly you do.
What do you mean by "neuronal activity"? If you're saying it's not just the electrical activity of the brain that constitutes the self, that seems to be true; electrical activity can come to a complete halt and be restarted without apparent loss of selfhood. If you're saying the self is something more than whatever the entire brain does--including neurons, glial cells, and all the rest--that's off in woo-woo-ville.
I didn't downvote you, but if I had, it would have been because "neuronal activity" seems like a strawman here, and I'm not sure where you got that idea. I would have started with synaptic connections myself.
The brain stores information in physical ways that don't get lost just because neural activity ceases for a while. One way is in the physical layout of the brain (what neurons are connected to what) which changes over time. Another is epigenetic changes in the genes of the neurons themselves which alter their behavior. The brain isn't a CPU or an artificial neural network where you turn off the power and lose all the state.
We've already known for a long time that people's EEGs can flatline without wiping out their memories and personalities, so this isn't exactly new information. But it is nice to see more confirmation that the brain is storing state in a different way.
"Another is epigenetic changes in the genes of the neurons themselves which alter their behavior."
Fascinating. I wasn't aware that epigenetics had a role in memory formation - I think I assumed it all happened at the electrochemical level. I found some information at [1] but its fairly impenetrable for a non-specialist. Anyway, thanks!
Who is downvoting all these comments made in good faith? The same thing is happening in other posts on the front page, and elsewhere on this page.
If you downvoted this, you need to go review the HN guidelines [1] and Paul's recent comments on what makes an ideal HN comment [2].
Downvoting is not something you do for a comment you mildly disagree with -- it should be reserved for posts that explicitly violate community standards. This is not one of them, regardless of whether or not you or I agree with the particular sentiment.
> But will it be the "same person"? Does cold-starting from the same neural network give you the same consciousness or a copy? Does consciousness require some form of continuity that's lost if you lower neural activity beyond a certain level?
The sense in which consciousness is used in the comment does not have a commonly held definition to my knowledge.
I would be surprised if the poster is using a personal rigorous definition of consciousness in the comment. I have not see a rigorous well defined definition of consciousness when paired with any question along the lines of "But will it be the same person?
I would say it could fall into:
"Please avoid introducing classic flamewar topics unless you have something genuinely new to say about them."
Though it is more of classic for using ill defined words and concepts that people nonetheless hold near and dear.
Though think it is a good police to only down vote a comment like that if the full conversation by the poster continued to use ill defined concepts rather then refining them through out the conversation.
I don't think that's a bad idea. However, anyone who has been around here long enough to accumulate 1000 karma (or whatever it is now) should know better than to downvote anodyne comments with which one mildly disagrees.
I think people are getting emotional about certain subjects and lashing out by downvoting any comments that provoke rational discussion on those subjects. In other words, downvoting exactly the kind of comments pg is trying to foster in HN.
This would make a lot of sense. Flagging clearly says "this comment is not appropriate on this site", while downvoting usually means simply "I don't agree with this comment".
Downvoting also means "this comment should be this high", however the problem is that there's o indication when a comment is at score of 1, so people would inadvertently push it into gray area.
Can you quit whining about downvotes? It happens. Just move on. You've made as many posts complaining about losing 10 karma as you have about the topic at hand.
Actually, I made this post before I even posted the other comment that was downvoted. This comment was made solely on the basis of others', not me, being downvoted.
Look, frankly, I've spent a long time here refraining from commenting about random downvotes (of others' productive, non-inflammatory comments -- even ones I disagree with; I rarely get downvoted). But there's been a sea change in downvoting over the last few weeks (I'm doing some quantitative analysis that I'll soon put up). I'm not going to sit idly by while one of the last bastions of rational discussion on the web goes to hell.
If you could accurately enough define all of the terms in your questions to the point that any imaginable evidence would answer them, I might be interested in the answers.
Unfortunately there don't exist definitions that concrete yet, which means that you haven't even asked a real question. That's why you're being downvoted.
That's quite understandable. But this is a question that's going to have to be answered at some point in the future, especially for legal reasons. I'm sure someone's already asked it with regards to cryogenics. I would personally prefer the procedure to death, but if it becomes widespread enough to be used for life extension, I'm not really sure.
If my consciousness dies, then the last function of my life would be giving my family and friends someone who would still love them and take care of them, and, in a way, it would be giving birth to a new life. It's something I'd want them to have even if I weren't there.
And if my consciousness lives, so much the better.
Before we discuss the continuity of consciousness after suspending brain activity like this, I think we should first demonstrate continuity of consciousness from one moment to the next.
Are you the "same person" you were one second ago? We all think we are, but there's no proof. The continuity we experience could merely be an artifact of memory, and not real. Me-in-one-second might not share consciousness with me-now.
It seems to be jumping the gun a great deal to try to establish this for exceptional circumstances before we establish it for the common everyday one.
>Does cold-starting from the same neural network give you the same consciousness or a copy?
You are making a rather big assumption that consciousness comes about because of brain activity. As far as I am aware this has not been scientifically proven. (I am not denying a relationship between the two).
given that consciousness is inherently subjective (I cannot assert that you or any other human being has a consciousness /lives a subjective experience.), I have doubts that the scientific method will be appliable someday to such a field.
Buddhists write a lot more logically than scientists on the subject. As they point out, "you can not observe an experience", and science relies on observing subjects.
That seems as silly as asking if when I reboot my computer is it has the "same" data or a copy. The bit pattern is the bit pattern. Another way to think about it might be "how would the 'copy' know its a copy? If it doesn't, does it even matter?
That is an interesting philosophical question, but it's mostly semantic. I would say that it's the "same person" just as much as you remain the same person as the cells and atoms making up your body are still you as they move through time.
Would it matter if it was a "copy"? Whatever that even means when we are talking about the same brain. It's certainly the same person with the same memories and everything. I don't see why going unconscious would change that.
The network is chemical, not electrical, so why would a freeze/thaw change anything? (unless it actually did have some chemical reaction, which hopefully wont happen).
Assuming that what we define as conscientiousness is just the way neurons connect to each other and the content of these neurons then as long as the neurons don't die your conscientiousness, personality, identity should not be altered.
That also means the the brain could be copied and we could be able to preserve people's conscientiousness.
How cool would it be if after you die you would still be able to exist as part of a vast network of interconnected brains able to manipulate virtual reality.
Who need AI when you could just upload yourself :)
Edit: Or you could clone yourself which is where it gets a bit weird since a clone would not be you and left to its own devices it would develop it's own conscientiousness, personality, identity however what would happen if you imprinted your neural pattern onto the clone.
Would that be a new person or just you in a new body.
Unfortunately, no, it doesn't, because there is no way we can "read" a brain. "Reading" tiny parts of a brain is possible, but requires destruction of a lot of other parts.
We have billions of neurons, and each neuron has connections to thousands of other neurons, and all of that is mashed together in a lump of gray mass.
Scientists today can map the structure of a handful of neurons in a single brain. A typical procedure might involve perfusing the organism with a chemical that plastifies the brain, and then cutting slices out of the brain.
Besides the fact that these mappings are just tiny 2D recordings of a tiny sliver of the full 3D brain, they are not precise enough to actually simulate the neurons. The connections between Neurons, the synapses, are so tiny that you need extremely complicated microscopes to see them, and you have to be fast because the light from the microscope actually destroys what you are looking at...
And, of course, the mice these brains come from will have some genetic modification that makes their cells phosporescent so you can see parts of them better.
>Taken to its limits, it is not known that information-theoretic death ever occurs. Physical information is not known to be destroyed, except by the controversial black hole information paradox; and as such, resuscitation is not specifically ruled out by the laws of physics, unless information critical to that resuscitation passes beyond the event horizon of a black hole.
what it is saying is that any physical system can be reversed (except when event horizon involved). The guy who wrote it seems to miss understanding of increasing entropy enabled by expanding Universe. Or in other words - good luck gathering back the butter spread on a hot bagel.
> (Personally, I'm interested to see if anyone reports any kind of dream-like experience while undergoing the procedure. I know, I know, it's impossible. Still fun to imagine our scientific understanding of the mind being turned upside down.)
There is a famous case from 1991 [0] in which a patient's brain was drained entirely of blood in order to operate on an aneurysm near the brain stem. Her eyes were taped over and ear plugs emitting loud clicks (> 80 db) were inserted into her ears and also taped over. These were used to determine when brain activity ceased. During the period in which there was none, she reported having a near death experience which also featured an out-of-body experience. She later accurately reported conversations in the OR, named the songs that were playing on the radio, and described the saw used to open her skull, a tool which was not wheeled into the room until after her brain death had been induced.
My abridged retelling of this most dramatic account comes from my memory of the book Irreducible Mind [1], which presents a vast corpus of evidence that the mind does not originate in the brain. The authors propose a different theory, the Filter or Transmission Theory of Consciousness originally proposed in the 19th century, but their main drive is really to provoke the further study of exhaustively documented empirical evidence that are at this time reflexively tossed aside as paranormal and unscientific. The evidence they present is compelling in its breadth, consistency, and in the reputability of its creators--most of the evidence they discuss is that reported by doctors, and as often as not skeptical ones who dutifully wrote down what they witnessed despite being unable to come up with a satisfactory explanation for it.
If you're interested in seeing our understanding of the mind being turned upside down, there is no need to wait for new reports to roll in, though I hope that with procedures like this becoming more commonplace they will do so. All that's needed is to take a critical yet unbiased look at the empirical evidence already compiled by serious researchers. One or two of the authors have a bit of a chip on their shoulders concerning the dismissal of evidence by mainstream science which made me wary when I encountered it. However their discussion of problems with current theories of mind and the evidence that uncovers them is rigorously scientific, clearly explained, and makes a pretty solid case that, if nothing else, our current theories are sorely lacking the power to explain real events.
I recommend this book to anyone interested in the science of mind. Even if you are thoroughly and inalterably convinced that NDEs, OBEs and the like are rubbish, this is the perfect book to read in order to argue against it because it will challenge you to defend those positions in a way that dreamy-eyed spiritualists won't.
That does sound interesting but I simply don't believe it unless it can be reproduced and studied, simply because of how extraordinary those claims are.
It's pseudoscience backed up by anecdotal stories which strike me very similar to stories about the paranormal or UFOs (not that it proves the stories are wrong, but that such evidence is horribly unreliable.)
Why even have eyes and ears if "souls" can apparently get sensory input without them? Why would people with brain damage have impaired cognitive function? Why would neurons act like the kind of complex information processing structures we would expect, if information was processed outside the brain? Why do MRIs and EEGs of the brain correlate so well with the mind? Why has no mechanism of this "transmission" ever been discovered? How would such a thing even be possible with the laws of physics? How would evolution evolve such a mechanism in the first place, or biology produce it through mere chemical reactions?
Nothing about it makes any sense. But a lot of people believe it anyways because religion.
Yes, the article is accurate. No, it tells us nothing new about thought and consciousness.
They're trying to make it accessible, but are just confusing matters. This is no different than resuscitating an otherwise 'dead' person with CPR, just extending the period they can be resuscitated.
If your heart stops or you lose too much blood, oxygen stops making it to cells, including the brain. After long enough, cells die (irreveribly/structurally). If you induce hypothermia, the processes that lead to cell death are slowed down so doctors have longer to fix the problem that led to hypoxia.
"Brain dead" refers to the condition of the brain after massive cell death. Brain cells are most vulnerable to lack of oxygen. That's why so many people's brains die before blood flow/oxygen can be restored, but the rest of their bodies are left in a functional state.
If your blood has been drained and there is no brain activity, then you are not alive, correct? And by today's standards most doctors would mark you as dead and ship you off to the morgue.
The concept of death can be challenged because dead really means 100% unable to bring back to life. It's not possible to bring dead people back to life, so people who are not alive, but not 100% dead beyond the point of no return, still have a chance to be alive again.
Basically there are two meanings of dead: "no neural activity" and "irreparable damage to the brain", if there is simply no neural activity but the brain is still physically intact, then you're in a pseudo-dead state.
The brain is truly dead when you progress too far in cell death. For example, when you die from drowning, you are dead because oxygen starvation caused too much cell death (and you can survive drowning even if you had some cell death, so long as it was limited).
There have been recent developments in the medical field that suggest that seemingly-dead avalanche victims, whose body temperatures have dropped to freezing or below and whose body functions have all but ceased, can be revived if you warm them... slowly. (Warming them too quickly causes some sort of shock)
There was also an article on HN 6 months ago or something, where a doctor rescued a person in cardiac arrest by keeping her head cold enough using groceries just bought in the supermarket (if I remember correctly) - at about 25-30C. The person was successfully reanimated about 4 hours after the cardiac arrest and suffered no brain damage.
I have seen fist hand someone who had drowned, no pulse, being brought back with CPR. It happened to be ice cold glacial melt kayaking in the Alps that they had drowned in. Not 4 hours, but a significant amount of time without a pulse and breathing. Apparently he was OK afterwards.
> Without oxygen the brain can only survive for about 5 minutes before the damage is irreversible.
>
> However, at lower temperatures, cells need less oxygen because all chemical reactions slow down.
While it may imply you can "restart" a body, it isn't what the article is saying. Simply the brain is running in a state where oxygen utilisation is so low, that it can survive without an external supply for periods of more than an hour (but definitely not for long periods). And, by replacing the blood, patients can be brought to this state much faster than other techniques.
"Is the article accurate? If so, does the ability to restart the mind from an inert brain tell us something important about how thought and consciousness works?"
The evidence points towards consciousness and thought being purely physical things inside of the brain. As long as the brain isn't damaged while off (which is difficult and what this research is trying to achieve) then there's not much reason why someone can't be "restarted", whether it's 10 minutes later or 1 year later.
"Every day at work I declare people dead. They have no signs of life, no heartbeat, no brain activity. I sign a piece of paper knowing in my heart that they are not actually dead. I could, right then and there, suspend them. But I have to put them in a body bag. It's frustrating to know there's a solution."
The above sentence basically sums it up. Our advanced medicine is constantly improving, but the current state of medicine is primitive on the scale of things that humans are capable of eventually fixing.
Can we eventually fix the spinal cord? Yes.
Connect to a brain via a BCI? Yes.
Restart the brain? Yes, as long as it's not destroyed first.
Also there is no reason that the brain can't be transferred. That's where the real discussions on consciousness begins. How slow does the transfer have to be so that we're really still ourselves?
I think the right way to have phrased this would be to call it "Extremely slow brain activity that it appears to be non existent in the traditional sense". Since the body is cooled down, all chemical reactions including those that take place in the brain are slowed down to a point where our traditional methods of looking at it suggest no activity. When it is warmed up, it should start functioning as usual. (This is what I understood from the article)
It would be interesting to see if the person's (who was brought back to life) notion of time was skewed. Perhaps he would feel like only a few minutes had passed, while in actuality he would have been operated on for a few hours. (Which asks the bigger question, of if our internal notion of time is based on the speed on chemical reactions in our brain/body)
There are other ways to do suspension as well. Certain gases are known to have the very same effect (induce clinical death, slow down your body metabolism) and the body can be restarted when oxygen is pumped in forcefully again.
Alas with the extremely slow state of regulatory changes, many people that could be already saved nowadays using these techniques are just ending up dead.
> Alas with the extremely slow state of regulatory changes, many people that could be already saved nowadays using these techniques are just ending up dead.
I think the article touches upon this, but it's a little more nuanced than 'regulatory changes', because with this technique there is no time for informed consent, and doctors understandably want to avoid a situation carrying out this procedure on a patient who then subsequently died but could have survived were another treatment approach taken.
On the one hand many people do end up dying prematurely because they were not able to benefit from the latest medical technology: on the other, but on the other these new technologies may have substantial short and long term side effects that we're not fully aware of yet.
To give you some examples: many medical professionals are now arguing for stronger regulation of antibiotics because a lack of prior regulation has resulted in widespread drug resistance. Ritonavir is a antiretroviral drug used to treat HIV which during clinical trials was very promising, but after being released was found to be polymorphic and convert in-situ to a different structure which was useless (the drug had to be taken off the market and re-formulated). Thalidomide is a classic case of a wonder-drug which subsequently was found to be wholly inappropriate.
I don't think anyone in the medical profession would argue we should deprive people of the most effective treatment - indeed, it is standard practice in a double-blind trial to halt the placebo participants if the drug being tested proves to be overwhelmingly effective, because it would be unethical to continue. However, it takes time, effort, money, and regulation to establish how that treatment works and what side effects it might have.
Unless we change the way drug companies are paid to develop antibiotics introducing any new regulation on the use of antibiotics won't be a good idea. Most have already canned their antibiotic r&d divisions because they can't make any money from new antibiotics since doctors refuse to use new antibiotics as they want to have a 'back-up' in case of resistance. This has created a negative feedback loop where drug companies stop developing new antibiotics since they aren't being used enough and doctors tighten the use of the few new antibiotics that make it through.
That may have been true a decade ago. Sadly there's plenty of money already to be made in treating MRSA, c. difficile, mdr/xdr TB, and (terrifyingly) VRE and VRSA.
New regulations on antibiotics is essential. The thought that it's not a good idea is outside of mainstream and defies basic common sense.
edit: sadly, I disagree with you. Drug resistance can and is driving new r&d because it's killing people. New drugs will probably be more narrow spectrum and lucrative, more due to the difficulty of finding effective compounds rather than any specific intent.
I don't know if there is plenty of money to be made on the development of antibiotics, but I do know that the heads of all the big pharmaceutical companies don't think there is.
More regulation preventing the use of antibiotics won't encourage pharmaceutical companies to invest in this area, only making developing antibiotics more profitable will. This can be done in three way:
1. Encourage use of the new antibiotics so they sell more.
2. Increase the price.
3. Pay the companies directly for developing a new antibiotic (X-Prize-like approach).
My personal opinion is that option 3 is the best way, but right now there is no mechanism for doing this on anything other than a toy-scale. What won't encourage pharmaceutical companies to invest in the development of new antibiotics is to restrict their sales and increase their costs via regulation.
> I think the article touches upon this, but it's a little more nuanced than 'regulatory changes', because with this technique there is no time for informed consent, and doctors understandably want to avoid a situation carrying out this procedure on a patient who then subsequently died but could have survived were another treatment approach taken.
Sure, i don't argue on that. What I mean is that even if their first trial is widely successful (they save 50% of patients instead of the standard 7%), how long will it take and how many trials will be needed for the FDA to recognize this as a new clinical practice? It will be years - and in this period how many persons who could have been saved by this kind of procedure will die? That's what I was referring to.
If we could tell, just from a single trial, whether a particular drug was safe and effective, then it's true that the subsequent FDA trials would be a huge waste of time. Sadly, history has told us time and again that we can't.
>how long will it take and how many trials will be needed for the FDA to recognize this as a new clinical practice? It will be years - and in this period how many persons who could have been saved by this kind of procedure will die?
what prevents doctors from doing it today? Nothing. Like in that case with brain cooled by groceries, doctors seems to be doing it when they can. Other thing is mass-training of doctors for some procedure - that requires that procedure should be developed to some "packaged" level. This is what FDA approval is part of and seems to be a reasonable part.
Are you advocating that medical regulations NOT be based on scientific evidence? Or are you simply saying that the FDA's standards for new procedures are too conservative?
The examples you give sort of prove the point. People remember bad drugs that killed people for decades afterwards. It sells papers, it makes regulations, companies get sued and people lose their jobs. No one notices when people die but could have been saved.
There is strong incentive to be overly conservative, but we should focus on the net deaths - having as few people die as possible.
I'm reading Erasing Death, a book about resuscitation by Sam Parnia, a doctor who specializes in it. He laments the poor state of resuscitation practice. Different hospitals have widely varying success rates, as do different doctors within the hospital. There's quite a bit of science on how to do it well, but very little standardized practice. It all comes down to what the doctor on call feels like doing.
The doctor's not necessarily up on current research, because resuscitation isn't any kind of medical specialty and there are no education requirements.
Every hospital I have worked at has a crash team. It is comprised of several people with various skills, all trained to a high level. They most definitely specialise in resuscitation. However they are not always called, aren't always fast enough, and can't be everywhere.
Name a few. If you reply, I'll do some research to see if it's as black and white as you're making it out to be, and reply back.
In the event you're talking about hydrogen sulfide (popularized via TED & Dr. Mark Roth), http://clinicaltrials.gov/ct2/show/NCT00858936 - their study was withdrawn by their own choice. The results weren't reproducible outside of mice.
Experiments on sedated sheep and partially ventilated
anesthetized pigs have been unsuccessful, suggesting
that application to large mammals may not be feasible.
Yes the (d)ethicists have so jammed up the drug development process with impossible safety thresholds that basically nothing new can now be tested in humans.
Can you effectively get the gas into the patient in the situations that they are talking about here though (heart stopped, so blood is no longer flowing through the lungs)?
Why are the researchers focusing only on knife wound and gun shot victims? I understand that those injuries are particularly sudden and severe, but so are many of the injuries associated with automobile accidents, which occur more frequently.
Of course, they need to introduce this technology in a small, focused way, but it would seem more logical to use a patient's physical condition as the deciding factor rather than his or her exposure to two specific crimes.
Knife wounds and gunshots damage specific small areas of the body which are rather better poised to benefit from the time gained with suspended animation to repair damage and stop bleeding, etc.
Car accidents give much more whole-body injuries which aren't nearly as readily apparent or fixable by sewing up holes. This is also obvious a tiny pilot project and likely wouldn't be restricted to gunshots and knives if successful.
Knife and gunshot wounds really just means penetrating trauma. There's a hole and it's bleeding, but otherwise the body and vital organs are fine. If you can fix the hole and stop the bleeding in time, the person will live. If not they die.
Contrast this with a car accident where massive blunt trauma forces have crushed and wounded lungs, livers, bones, etc. There's no one "hole" to fix, just blood oozing from thousands and thousands of micro tears. Surgery won't fix these people.
Most of the damage from a gunshot wound doesn't come from the hole, but rather from the cavitation the flesh is subject to as the bullet passes through it. The shock wave from a physical impact of that magnitude absolutely rends flesh.
Most urban/non-military gunshot injuries are from pistols, which have a fairly negligible temporary cavity since they're relatively low velocity (order of 1000fps, vs. 2500-3000fps for a rifle round). Plus, they're often expanding ammunition (hollowpoints, etc.) which do more direct tissue damage.
Military rifles, firing FMJ ammunition, do have a huge temporary/cavitation trauma vs. direct trauma (unless they hit bone).
See my comment elsewhere in this thread; Martin Fackler and his followers believe temporary cavitation trauma is "at best a secondary mechanism, if not irrelevant."
Although I have a personal theory about why FMJ battle rifle (e.g. 7.62 NATO/.308) torso wounds tend to be fatal, at least in the field: there larger temporary trauma diameter stands a good chance of shocking the spine and disabling long enough for person to bleed out unless someone else quickly comes to their aid.
This is highly debatable, and as noted almost entirely irrelevant for urban crime gunshots, where muzzle velocities don't go much above 1,000 fps.
If you follow the Fackler school of "terminal ballistics" as I do, even for rifle velocity wounds this is "at best a secondary mechanism, if not irrelevant." (http://en.wikipedia.org/wiki/Martin_Fackler). It's the "permanent wound cavity" or ""permanent crush cavity" that does the real damage, soft tissue appears to be awfully good at getting pushed to the side and springing back.
Saline is easier to find than blood, and you don't need to know the blood type when it comes to an emergency. Saline is standard and available in large quantities everywhere in hospitals, and very cheap. It makes sense.
Well this is unfortunate... I came to this thread way too late and I doubt people will see my post. I am a physician and I know a lot about hypothermia and its uses in medicine. Oh boy, where to start...
First of all, death is a really nebulous concept when you understand physiology at the cellular level. We still do not know the signs that represent irreversible death at the organismal level. The heart can be restarted, consciousness can be lost and restored (coma, concussion), and even the entire cardiovascular system can be bypassed in emergency situations (Google: ECMO). I mean, we accept that decapitation is a non-survivable condition, but is that person dead at 10 seconds? 1 minute? 10 minutes? What if they could be revived in body, but their cognition/personality information was all lost... are they alive? It's really controversial and hard to define. So instead we make definitions of cardiovascular death and brain death so that we can make laws and regulations regarding the issue. But scientifically? Yeah, good luck with that.
Now accepting that there is no 'on/off' switch of life and death, we must come up with ways to preserve to most 'at risk' parts of the body to preserve life. In this case, the brain. 5-10 minutes tops without oxygen and you are death for all intents and purposes--an exception (which they kept forgetting to mention in the article) is that you aren't dead until you are 'warm and dead.' There are plenty of cases of hypothermic 'dead' that could be rewarmed and they 'come back.' Are they intact? Absolutely not! Most of them suffer short term memory loss and spastic muscle issues (the most susceptible cells to anoxic injury are namely the hippocampus and purkinje cells in the cerebellum--both of which would be expected to cause these symptoms if injured). Using rats and pigs to model recovery in hypothermia (which has been done as far back as the 80s) is misleading because you can do things to them that you can't do to humans. Namely, subject them to high-risk, experimental procedures without their consent. This is an unusual study because they WILL be doing just that--bypassing consent to give these people presumably the only chance they have to survive. In past studies of hypothermia, people could not be consented fast enough or they couldn't be cooled fast enough (an entirely different discussion). The key is the immediate cooling. If you can get their temperature low enough, quickly... you can preserve almost all brain function. Again, we know this from cases of frozen lake drownings, hypothermic cardiopulmonary bypass, etc.
So, yes... this trial is promising... but I am afraid that it will be difficult to do it right. The fact is that getting central arterial access to 'replace their blood and cool them' is not as easy as it's made out to be. Plus, if they have that much blood loss... those injuries need to be repaired and that same fluid being pushed through those injured vessels, is now just pouring out of those same injuries. Yes, it may work in some cases... but overall, traumatic injury is a very heterogeneous group.
In the group that they describe who will receive this experimental treatment, I fear that they will have already had too much ischemic time--too much time without significant blood pressure. High-quality CPR is rare in the field, and even in the hospital can be sometimes missing. Assuming they have been getting 'good' CPR for the 10-15 minutes the ER team spent attempting to resuscitate them, there is still a good chance that their brain was not being perfused.
IMHO, this trial will unfortunately not give positive results. The science works in principle, but not in practice.
That being said, the 'holy grail' would be a drug/chemical that could slow cellular metabolism. Emergency responders could inject this at the point of triage and then hold them in 'stasis.' One day, we will definitely have this... but there are no good compounds in the pipeline to my knowledge.
EDIT: I think I gave the false impression that I don't support the study. Actually, I DO! I was just speaking about the existing human studies that are out there. I think it is both ethical and important that we continue to investigate these interventions.
Haha this is incredible! I've never seen these surgeries. Technically you could do this on a person too, I don't see any reason it wouldn't work. Of course, with our current level of scientific understanding, we have no means to 're-connect' the spinal cord--that is currently our rate limiting step in surviving a controlled decapitation, say one performed under hypothermia in an OR suite. We could use a bypass machine on a severed head, but it would still be a quadriplegic and unable to breathe for itself.
Futurama's 'heads in bowls' is not so far-fetched if we never figure out our to reattach a spinal cord.
On the other hand, it is my understanding that in Vietnam, brain injury surgeries without anesthesia and going in through the roof of the mouth instead of the skull were pioneered on seriously injured soldiers which yielded important forward progress in how to improve brain surgery. So if these patients would currently die anyway, it gives them a shot they don't currently have and is a potential learning experience for medical practitioners.
When current methods lead only to death, there is no real downside to trying something new. We know exactly what we are doing and it leads to certain death versus we don't really know what we are doing and it leads to probable death -- most folks will take the "probable death" option.
oh actually I agree with you completely! Don't mistake my negative impressions of the study... I am being purely objective based on existing evidence. Subjectively, I think we should continue to do everything we can to advance this area of knowledge and think it is ethical to do.
My bias is showing. I have a deadly condition and when doctors wrote me off, I began trying stuff. I didn't die. I got better. So I was kind of speaking from first-hand experience, which tends to be kind of biased. I generally read as a Shirley Temple-esque optimist type, not because I am naïve but because I know firsthand what can be done when things can't really get any worse so you decide to try "the crazy thing".
The self-interventions you've discussed in the past aren't at all comparable to, say, inducing hypothermia... and if they were so easy a cure for CF then I'm not sure that pleading bias against housewives with one weird trick would really serve to explain why remotely plausible cures to CF aren't in broader trials.
I have a form of cystic fibrosis. I was not diagnosed until my mid thirties. It is genetic. After I was ID'd, they tested my sons. My oldest has the same diagnosis. I spent about 3.5 months bedridden prior to the diagnosis. After the diagnosis, doctors told me "people like you don't get well." Given that I had managed to live that long without a diagnosis, I figured that, armed with new info, I could surely improve on my track record.
Thirteen years later, I am drug free, the hole in my left lung has healed up, and most of the world thinks I am a teller of tall tales. I talk a lot less about it than I used to. I would like to help other people but talking about it mostly gets a shitstorm of controversy aimed at me. Apparently, former homemakers aren't allowed to know more than doctors. Or something.
If you wish to discuss it further, I suggest you take it to email.
What do you suggest in place of this trial? When you are trying a new method on a patient who is certain to be dead if current options are followed, what have you left to loose?
I agree with you. I think it is both ethical and important to do this kind of study. I'm just speaking from the perspective of existing human trial data--I think it will be difficult to find a significant difference in outcomes.
I remember reading about this research in pigs many years ago and over the years I kept wondering "what's going on with this?"
If they can make this work only in a statistical sense, reviving more people than would have died otherwise, it'll lead to even more research. My firm belief is that this is one of those things that the more we do, the more we'll be able to do. It wouldn't surprise me to see people being "dead" for 4-16 hours then brought back to life -- assuming a decade or two of research.
At that point, all kinds of weird things become possible, like head transplants, or people who have lost their body from the navel down being saved.
Credibility for cryonics in the medical community is more likely to emerge from the application of vitrification to donor organ preservation, I think, which is where inroads are being made by groups like 21st Century Medicine.
But credibility with the public follows its own strange laws, seemingly immune to logic and the voice of the research community in some areas. So who knows, you might see some sort of transference of credibility via magical thinking, in that both involve cold.
Would cryonics be possible if you were to chill someone to just above freezing? Cold enough to slow cell processes to a standstill but warm enough that you don't cause cellular damage from the freezing process.
edit: The stumbling block for cryonics the massive trauma to cells at a molecular level from freezing. If I have to bet, that never gets solved and cryonics is a pipe dream. So, I didn't mean to be so blithe, but this offers no new information that's relevant to the viability of cryonics.
edit: I'm aware of vitrification. Vitrify and revive a human, then. It's a safe bet that it's not a perfect process at the scale of a whole human body.
Science fiction is becoming medical practice. In Lois Bujold's Miles Vorkosigan books, the main character is killed by a grenade to the chest. The emergency medical procedure was to dump the lower-ranking dead body already in the portable body freezer, exsanguinate the corpse by opening the carotid arteries, and pump the circulatory system full of "cryoprotectant fluid". The body is then frozen. Replacement parts are grown from the corpse's own tissues, which are surgically implanted when the body is thawed in a fully equipped, state-of-the-art medical facility.
In the context of the fiction, the procedure was imperfect, and is not without side effects. The frozen dead people often fail to revive. The main character, for instance, was left with a debilitating seizure disorder for the remainder of his life, something that was eventually treated by a neurological pacemaker implant.
Based on existing studies and technology, the fiction is a very plausible future technology. Between stem cells, volume printers, and extracellular matrix, autologous donor organ replacement seems possible. Hibernating amphibian studies tend to indicate that a blood replacement containing glycerine, perfluorodecalin, raffinose, glycogen, and drugs would help minimize human tissue damage from the freezing and thawing process. It would be an emulsion, and would probably superficially resemble the android blood from the Alien movies.
The only question, really, is whether the person that wakes up after surgery is the same person that "died" beforehand. Is it really saving someone's life, or is it just replacing them with a simulacrum that has their memories? And that question hardly matters at all.
> "We are suspending life, but we don't like to call it suspended animation because it sounds like science fiction," says Samuel Tisherman, a surgeon at the hospital, who is leading the trial. "So we call it emergency preservation and resuscitation."
Because that doesn't sound like science fiction at all...
The technique involves replacing all of a patient's
blood with a cold saline solution.
The technique was first demonstrated in pigs in 2002 by
Hasan Alam at the University of Michigan Hospital in Ann
Arbor, and his colleagues.
Their blood was drained and replaced by either a cold
potassium or saline solution, rapidly cooling the body
to around 10 °C. After the injuries were treated, the
animals were gradually warmed up as the solution was
replaced with blood.
Surgeons are now on call at the UPMC Presbyterian
Hospital in Pittsburgh, Pennsylvania, to perform the
operation. Because the trial will happen during a
medical emergency, neither the patient nor their family
can give consent. A final meeting this week will ensure
that a team of doctors is fully prepared to try it. Then
all they have to do is wait for the right patient to
arrive. When this happens, every member of Tisherman's
team will be paged.
The technique will be tested on 10 people, and the
outcome compared with another 10 who met the criteria
but who weren't treated this way because the team wasn't
on hand. The technique will be refined then tested on
another 10, says Tisherman, until there are enough
results to analyse.
"...we don't like to call it suspended animation because
it sounds like science fiction..."
says Samuel Tisherman, a surgeon at the hospital, who is
leading the trial.
"After we did those experiments, the definition of 'dead'
changed, Every day at work I declare people dead. They
have no signs of life, no heartbeat, no brain activity.
I sign a piece of paper knowing in my heart that they
are not actually dead. I could, right then and there,
suspend them. But I have to put them in a body bag.
It's frustrating to know there's a solution."
says surgeon Peter Rhee at the University of Arizona in
Tucson, who helped develop the technique.
Is this right? That seems to imply that brain activity can be restarted from a cold, "electrically" inactive mass of grey matter. I thought brain dead was dead and there was no coming back from that.
Is the article accurate? If so, does the ability to restart the mind from an inert brain tell us something important about how thought and consciousness works?