When the Alcor management changed in September 2005 to the current team, we developed a new policy of not talking about what grand plans we have for the organization, instead choosing to talk about things that we have completed. We implemented this policy change because the management team (consisting of Steve Van Sickle, Jennifer Chapman, and myself) were disappointed members. We were all weary of the empty promises, the distinct lack of improvement in technical capability and the lack of responsible fiscal oversight. We very deliberately set out to rebuild Alcor into an organization of which we could be proud, and we were enthusiastic about bringing positive change. Though it is a lengthy process, in my opinion we are succeeding, and we’d like to present a little perspective on the changes of late and on the challenges yet ahead.
Our staff is highly motivated and productive. We have an internal plan of action that the staff has been implementing for the last eighteen months. This plan relates directly to the two things Alcor needs most in order to transition beyond the tiny startup company it has been for the past 35 years: better evidence and professionalism. It presents a plan for developing an infrastructure to meet both technical and administrative requirements that are necessary to a growing membership. It also contains some underlying assumptions.
The first assumption is that cryonics will never be particularly popular as long as people consider it an alternative method for disposing of a deceased human body. Cryonics is about saving lives, and medical professionals should perform cryopreservations in hospitals. Social acceptance and scientific credibility are essential to accomplishing this goal. In order to realize this (admittedly long-term) dream, we need to prove that cryonics can do what we desire: preserve the biological viability of a body and brain for future revival. This demands more research.
In the past two years, Alcor has built and is using a fully functional cardiopulmonary bypass lab. We are committed to testing all aspects of the cryopreservation protocol in an attempt to establish which portions of the procedures protect the biological viability of tissue and which do not. A single researcher can operate efficiently in this lab, but so can several should the funds become available for additional hiring. Real, publishable, replicable research is critical to proving that cryonics is more than a fiction. That research will take many years, but we have begun.
The second assumption is that research alone is insufficient to ensure we provide quality care to our members. It is quite difficult to take a procedure that works on a small model under specific laboratory conditions and move it into the homes, hospitals, hospices and medical examiner’s offices that our patients require. Each of these environments has unique challenges. As a person who has seen all of these environments up close and who has helped develop much of the current (and pending) capability, it is my contention that we do not have a scalable system and that the training we currently do is inadequate.
Our current training regimen is capable of teaching cardiopulmonary respiration techniques (which we call “cardiopulmonary support” because of the difference of endpoint) about as well as any conventional CPR class. We can teach the theory behind the airway management, placement of an IV, medications administration, surgical technique, and blood washout that our protocols require. We cannot currently guarantee a member of the stabilization team any real practice, because of how infrequently our cases occur. We cannot give them anything but theory and practice with mannequins. This is untenable, but we know several ways to fix it.
Our current stabilization kits are also inadequate. It is true that these kits allow us to provide the level of care we have always provided, but the truth is that they need upgrading. The kits themselves are unwieldy and less portable than we would like, and advances in medical equipment and the cryonics-specific equipment have not been propagated to the regions. This also is a solvable problem.
Having stated decisively that our stabilization and training elements are inadequate, I must emphasize that our standards have risen significantly over previous administrations. We are not satisfied with simply maintaining the status quo as we have done for so long, but are instead dedicated to providing the best quality of care to all members. We believe that this quality of care should not be dependent upon proximity to Alcor and that only accidental or sudden death scenarios (with their incumbent legal requirements) should change the protocol implementation. We have a lot of work ahead of us to make this so.
With our small animal lab in place and fully operational, it is time to extend our attention to the construction of a second operating room. This OR will provide back-up cryoprotective capability to our main operating room (which has provisions for performing a single whole-body cryoprotection and a single neuro simultaneously). It will also provide us an environment for equipment testing and training that does not temporarily compromise our ability to provide member cryoprotections.
Equipment testing is necessary prior to deployment for patient care, and our engineering tests of new devices have taken us only so far. We need to use the equipment on a large animal or a cadaver to ensure it will work as intended. Our new whole-body vitrification system (consisting of automated perfusion and data collection systems and new patient enclosure) must be tested thoroughly, as must our newest versions of the air-transportable perfusion system, liquid ventilation system and ice bath. We are rebuilding the stabilization kits as well and will need to train the teams on modified elements. A second operating room will facilitate that.
Major change will occur in our training regimen once this operating room is complete and the training materials revised. We will finally be able to provide comprehensive team training at Alcor. Training will include not just the theoretical and the small sampling of practical aspects that we currently teach. We will be able to add femoral cannulation, perfusion, intravenous access, and airway management with real-time data collection and analysis. We will be able to extend our training to include the cryoprotections and their related surgeries. We can even train on the cool-down procedures in place to provide additional redundancy in that area.
More and better training will mean that Alcor has the potential to attract additional medical and scientific professionals. They will have the opportunity to expand their skills and will be taught by other medical professionals. (A perfusionist will teach the perfusion module; a veterinarian will teach swine anatomy; a funeral director can teach rapid femoral cut-down; etc.) Several new professionals have become involved in Alcor because of our growing research capability, and we hope to extend their involvement to the practical applications as well.
It is true there have been problems in the past, and things are not perfect now either. Alcor has been open and honest about issues we face with the membership. One of our biggest challenges is cash flow management. Cash flow is especially tricky to manage at the end of the year, when both donations and membership income slow. No money is being “wasted” and we have financial controls in place to reduce the risk of funds being stolen (or to ensure any theft is quickly discovered). Furthermore, the past two years have reflected more stability in fiscal management than was present in the previous administrations. For starters, we budget rigorously.
In order to answer a question of what fraction of operational activities is covered by membership income, I compiled the following table. The numbers for 2002 – 2005 were taken from our published financial statements (with the exception of the patient care figures, which were taken from the accounting database, because they are not broken out in our financial statements). For 2002 and 2003, the bequests and donations a single figure on our financial statements. The 2006 – 2007 figures came from our accounting database. (Our new accounting firm is preparing these financial statements, and the numbers may be subject to editing later.) Because our 2007 financials are in development, the patient care depreciation expense has not yet been included.
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As you can see from the data, fluctuations in income versus expenses have stabilized significantly. We have reduced our regular expenses through a series of cost-cutting and consolidation efforts; we’ve renegotiated multiple contracts for more favorable terms; and we’ve instilled a culture of frugality among the staff. Furthermore, the net surplus figure emphasizes the dramatic fluctuations in cash flow previously experienced by the organization, and we are pleased that these fluctuations have diminished.
Better management of assets means that we have been able to grow the staff slightly and accomplish more toward our core mission. In fact, the numbers for 2007 would have been starkly similar to those for 2006 if we had been paid for the cryopreservation of member A-2309 (a case in litigation because a family member objected to the disposition) and if the Life Extension Foundation had not withdrawn its support of Alcor in favor of other cryonics organizations.
Our financial strength is growing. We still have a ways to go to ensure cash flow is adequate for our needs and for the needs of the additional operational elements we still wish to add, but the trend is moving distinctly in the correct direction. Fortunately, we still have a contingency fund (one which we would like to make a true endowment some day) to cover the periodic deficits in operational income.
The membership growth rate is another aspect we monitor closely, and the rate is less than we would like. Our historic trend is that every two people completing the application process, one departs. Last year, our departure rate was slightly less than average, based on data collected for seven years. We recently started tracking the reasons for these departures.
In the past two years, we have asked people for their reasons why they are canceling their cryonics arrangements, and 11 of the 46 for whom we have data changed their opinions about cryonics as a whole. Financial reasons were the most significant factor, resulting in 34 of the 46 departures. Of those, we canceled 17 ourselves because our routine administrative oversight uncovered lapsed insurance policies. We canceled another 12 for non-payment of membership dues. Five members left of their own accord for personal financial reasons, stating that they intend to return when their situations improve. Only 1 member responded that he planned to join another cryonics organization.
As far as improving the growth rate itself, we have recently implemented new processes that immediately caused an increase in new applicants. In December 2007, 22 people started the application process, our greatest influx since we last increased the cryopreservation funding requirements. Only time will tell if this will become a trend, rather than a blip. We will continue to report on these efforts in future months.
We have additional plans to streamline the membership process. Things like putting the application online as a form, consolidation of the legal documents into a slightly less-intimidating pile, encouraging more regional gatherings, and hiring another administrative staff member are all under consideration. We do not know what makes an individual choose cryonics today, but we can simplify what is required as we collect more data.
We also wish to improve our communication efforts. We believe our members and supporters would benefit from diligent reporting on a more regular basis, and we absolutely need to fix our public cryopreservation case reporting system. (We accepted professional advice on that a few years ago and do not like the outcome.) This will be a work-in-progress for some time to come.
As an example, we prefer to report cases in full, but anyone who has ever attempted to compile one of these reports knows that this is not a simple process. It is difficult to compile accurate timelines, small stabilization teams mean sometimes data is not recorded, and the sheer volume of information is overwhelming. Our new data collection systems (currently being tested as part of the new whole-body vitrification system, later to be incorporated into the stabilizations) will make case reporting significantly easier and faster to complete. We will still have to write the narratives, but the data will literally graph itself.
In addition, we established this corporate blog in the hopes of providing the staff and directors with a venue for more regular reporting. It has not worked as well as we might have hoped, but we are still looking for the best way to make use of this tool. We continue to provide annual reports to the membership through the magazine. We would also like to remind people that if you want to know something, it really helps to ask. Our staff and Board members are extremely open to communicating with members and prospective members.
The staff or Board will not discuss some aspects of the operation in public. It is our policy to remain silent on issues of member and patient confidentiality, employment, legal strategies or settlements, unprotected intellectual property or the intellectual property of other organizations for which confidentiality agreements exist, and patient or facility security. All of these are in place to protect the patients, the members, the staff and the organization as a whole. We face greater risks of lawsuit by neglecting these policies than we do from enforcing them.
To conclude, I want to emphasize that the management team of Alcor and the Board of Directors are not blind to the challenges we face in overcoming 35 years of legacy problems; but we are all deeply committed to creating an organization that will last until our patients are well again. We do not underestimate how difficult some of these challenges are, and we are working as hard to overcome them with all the resources at our disposal.
In the coming months, we will periodically choose an element of our three-year plan to share. It is, by necessity, of a complicated design. By taking it one step at a time, we hope to ensure our members and supporters have an understanding of where we are going and why. We hope that taking this step will grow confidence in our organization and in Alcor’s ability to achieve its mission. We welcome your thoughts.