By Max More
Alcor President & CEO
Imagine ten years from now. September 2029. What will Alcor be like then?
The best answer: No one knows. Our historical growth rates have been variable. Too many wild cards, both positive and negative, could knock off any projected trajectory. Even so, I see value in running scenarios of possible futures. These help us plan for plausible futures. A real scenario exercise takes much time and work and typically results in a few plausible outcomes driven by a small number of driving forces.
What I’m presenting here is a toy-scenario exercise. Only one scenario is presented. This is not a predictive scenario. Again, too much uncertainty exists to say that the presented scenario is the most likely. However, I have picked the underlying assumptions because I believe they are plausible and may be attainable but not easily. Consider this as a modestly aspirational scenario. If things go well – although not as well as we might easily imagine – this is the situation we could find ourselves in. These are the resources we could have and the challenges we could face.
Quick side-note: Any substantial change from the status quo may seem implausible to those who look at the painfully slow progress we make month by month and year by year. But it adds up. If growth in membership stays fixed in percentage terms, the power of exponential growth eventually starts to look interesting – and, eventually, impressive. For historical perspective, when I joined Alcor in 1986, if memory serves, I was the 67th member and the number of patients was in the low single digits. Alcor was housed in a small facility in Fullerton, California, and had almost no paid staff. Although it’s taken far longer than it would in an ideal world, we have come a long way since then.
Baseline: Alcor as it was on August 31, 2019:
Total membership: 1,731
Last-year dues income: $556,000
A very small in-house standby, stabilization, and transport (SST) capability expanded by two contractors.
Larger membership and financial resources do not guarantee better response capabilities or stability, but they certainly make it easier and more likely. Qualitative factors are extremely important but cannot be quantified nor easily presented in a quick scenario exercise. The following will primarily but not entirely focus on quantitative measures. That should not be taken to mean that they are the only – or even the most important – factors in Alcor’s long-term success.
Membership numbers: At the end of August 2019, we had 1,269 full (cryopreservation) members. Growth in membership has bounced up and down and all over the place. The highest growth rates (so far) were seen in the earlier years. For instance, in 1986, the year that I joined, membership grew from 71 to 85, a gain of 19.7%. In 1991, membership grew at the fastest percentage rate ever of 44.7%. That then slowed to 25.7% in 1992, 7.9% in 1993, and a negative 4% in 1994. We haven’t seen double-digit membership growth since 2005, when it hit 10.2%, although we came close in 2018 with 8.14%. For my modestly aspirational scenario, I’m assuming an average 8% annual growth in membership.
Given an 8% annual growth rate, in ten years Alcor would grow from 1,269 full (cryopreservation) members to 2,740. Total membership would grow from 1,731 to 3,740.
In the decade leading up to 2029, the growth in membership was assisted by an online signup process. Retention of members was helped by a website with member portal.
Number of patients: Currently, we have 172 patients. Projecting the number of patients ten years from now based only on membership numbers is iffy. For one thing, our best actuarial analysis suggests that we should expect 12.8 cryopreservations per year. Yet we have only reached that once, with 13 in 2014. This could be a statistical accident. Or it could be that Alcor members, on average, have a longer life expectancy than the broader population. Given that life expectancy roughly corresponds with education level (among other relevant factors), this isn’t too surprising. But it is hard to quantify precisely.
In the last full six years, we have cryopreserved 51 members. That averages out to 8.5 per year. Well below the actuarial projection. Given this divergence, I’m going to simply assume the following numbers of new patients over each of the next ten years: 11, 11, 12, 12, 13, 13, 14, 14, 15, 16. That yields 131 new patients, for a total of 303.
That’s quite a few additional patients. It’s about the same as the total number of patients in 2012. Can we handle them all? Yes! Not so long ago, Alcor expanded the Patient Care Bay. We have also started a move to the new SuperDewar design formulated by Steve Graber. We have not decided on the future mix of Bigfoot dewars vs. SuperDewars, but let’s say we stored future neuro patients in the existing Bigfoots and whole body patients in the SuperDewars. The requirements for the decade ahead would amount to 1.5 Bigfoots, and 6 SuperDewars.
Financial: Alcor has three major Daily and ongoing activity at Alcor depends on operating income. That income flows from several sources but I’ll consider just membership dues and Endowment Fund income, since donations and other sources are more unpredictable. Membership dues in 2018 yielded $556,000. (An amount nowhere near enough on its own.) Assuming dues don’t change and that, as above, Alcor’s membership grows at 8% per year, ten years from now dues should bring in around $1,200,000.
Another source of operating income is the annual distribution of approximately 2% from the Endowment Fund. That fund held $6.3 million on June 30, 2019. Given the investment strategy being used, I’m going to assume 7% annual compounding. Compounding alone should bring that number up to $12,393,000.
But the Endowment was created with a major bequest. We can hope that further bequests and other contributions will be made over the next ten years. These could easily dwarf the current total, but I’m going to assume (pretty arbitrarily) an injection of funds over ten years that is similar to the starter funding. Let’s say this adds a little over $3 million to the total, giving us a grand total of $16,000,000. Yields $320,000 per year for operations. With a 2% draw, this yields $320,000 per year for operations.
So long as other sources of operating income do not dry up, this means that Operations should have over $800,000 per year as compared to today. That would enable us to hire more technical, medical, and other staff, and to improve response capability, security, and to advance on many other fronts. I believe we are now in a position where we can double membership without doubling staff. If that’s correct, then we will reap economies of scale as we grow.
Alcor Care Trust Supporting Organization (ACT): Assume 5% annual compounding – because the investment strategy is more conservative compared to the Endowment. On June 30, 2019, the ACT had investments of $14,163,000 (and total assets of $16.8 million). Compounding annual at 5%, we get $23 million. I will assume an additional injection of $3 million from bequests and donations. Of course, there will be further income from payments to the ACT for every patient. Given my assumptions about the number of patients per year, I figure this adds another $9,169,000. That comes to a total of $39,169,000. That’s a conservative estimate (given my assumptions) because it doesn’t include investment gains on the donations or on the cryopreservation payments.
The maximum 2% draw from this would yield $703,000. That’s close to three times as much as the ACT/PCT expenses in 2018, but with less than twice as many patients. This suggests that the finance for patient care are in good shape and will get better over time. We should be able to reduce the draw below 2%. That enables the fund to grow faster, generating funds for eventual repair, revival, and rehabilitation.
Non-financial projections are more subjective. Here is an aspirational view of where we could plausibly be in ten years:
Basic kits (most importantly including anti-clotting agents) are positioned in half a dozen areas in the US with a substantial number of Alcor members. Several more kits positioned in other countries in order to avoid customs problems.
Intermediate temperature storage (ITS) is available for both neuro and whole-body members.
Public awareness of cryonics and of Alcor specifically has grown greatly. Press coverage remains mixed but has continued the trend of becoming more favorable and fairer. The stream of inquiries about membership has growth strongly. Alcor has a far more advanced approach to responding to cryonics coverage in the media by writing editorials, issuing press releases, and providing tailored information to journalists.
Also continuing the trend of the previous decade, doctors, hospitals, and hospital administrators more often understand what we are doing and are willing to cooperate or at least not hinder us. This has been helped by more advance planning in the form of communication with hospitals and concise information about our procedures in both text and video form. Better cooperation has also resulted from Alcor’s persistent drive to get members to provide HIPAA forms, to choose a suitable medical power of attorney, and to include strong incentives to dissuade relatives from interfering with their wishes and arrangements.
The attitude of scientists remains mixed. Plenty of critics remain. However, many more scientists now either refrain from harsh criticism or say that cryonics might work. This is due both to greater public awareness and to Alcor’s focus on funding and publicizing research that conveys promising results. Theoretical arguments have been increasingly supplanted or augmented by evidence-based arguments.
In 2029, Alcor still must pay plenty of attention to legal and legislative considerations. As more people become aware of cryonics, Alcor has had to do more to anticipate, inform, and respond to potentially damaging legislation and regulation. The organization and the interests of its members have been strengthened over the past decade thanks to a tight review and revision of member agreements, updating of older agreements, and a stipulated change of venue from California to Arizona for disputes.
During the decade leading up to 2029, Alcor and cryonics in general faced another major challenge in the form of proposed government regulation. Fortunately, Alcor had in place legislative consultants who tracked potentially problematic proposals and friendly contacts with politicians who were well informed. Legislators treated us more fairly and reasonably in part because we had detailed information about our organization and operations in the form of a Handbook and numerous SOPs.
To conclude, I want to emphasize that this is a proto-scenario exercise, not a through exercise. I think it could be useful as it is and because it may help us step outside today’s perspective and see more clearly ways we need to plan for the future. When we have the time, I would like to engage in a more thorough scenario exercise, with inputs from all relevant parties.
DISCLAIMER: No one has checked my numbers and I wrote this in a hurry. Corrections welcome.