AwareofAware

Trailblazing

The second paper that I am going to review while we wait for the publication of AWARE is the seminal study published in the Lancet in 2001 by Pim Van Lommel, “Near-Death experience in survivors of cardiac arrest: a prospective study in the Netherlands”. This study actually began in 1988, and was carried out in 10 hospitals in the Netherlands. It was the first prospective study examining the phenomenon of NDEs in patients surviving cardiac Arrest (CA). Prior to this everything that had been presented or published was from retrospective studies which are open to criticism due to factors such as patient self-selection and long periods of time between the event and interview.

In this study, consecutive CA survivors were interviewed within a few days of resuscitation. Follow up interviews were conducted 2 years and 8 years later (hence the long period between initial enrollment in 1988 and publication in 2001). A number of baseline variables such as: demographic, pharmacological, physiological and psychological factors were recorded and compared between those who had NDEs and those who didn’t. NDEs were scored according to a weighted core index, determined by the presence and quality of 10 core elements (awareness of being dead; positive emotions; out of body experience (OBE); tunnel; communication with light; observation of colors; meeting dead people; life review and presence of border).

I am not going to repeat all the results, which are in the abstract at the end of the article, but as with the Greyson paper, I am going to highlight the most interesting points, and discuss the author’s comments:

• A total of 18% had some kind of experience, with 6% having a superficial NDE, and 12% a core NDE, 7% had a deep experience. Van Lommel suggests that this may have been an over representation of true NDEs as the weighted index created false positives. In his conclusion he suggests that the true proportion of people having NDEs is in the range of 5-10%. Like Greyson he suggests that the fact that not all people who survive CAs do not have NDEs is possibly due to problems with short term memory. This is supported by two pieces of evidence from this study:
  • Age is a determining factors of whether an NDE is reported. Patients who are younger are more likely to report an NDE. Short term memory deteriorates as we grow older, so this is certainly a possible explanation.
  • Length of time that CPR was undertaken was also related to frequency of NDE, with longer times reducing the number of reports. Long periods of CPR are also associated with subsequent problems with short term memory.
• Women, who were generally older than men, were also more likely to have an experience than men. Again this is a very interesting finding, and one that I will refer to at the end.
• This study had a notable, and now famous, “veridical” OBE (the only time I ever come across the word veridical is in relation to NDEs, and seems to be used to create an extra layer of jargon that the user hopes will lend scientific credence to reports. In reality it just means truthful, and relates to the fact that the account of the OBE had an independent witness to the events observed that corroborates the OBE account.) In this account a subject who was in a coma after a CA, had his false teeth removed by a nurse. She placed the teeth in a crash car, and forgot about them. A week later, when the nurse went to visit the patient, he recognized her and told the other carers that she knew where his false teeth were. The nurse reported that he was definitely in a coma, and could not have possibly seen or known what she did with his teeth, or the other events that he reported.
• Other titbits:
  • Patients with more resuscitations had a higher chance of experiencing an NDE – if they had two CAs, they may only have had one NDE.
  • No relationship between frequency of NDE and time to first interview (memory of the NDE, once established, didn’t deteriorate)
  • Interviews 2 and 8 years later showed that patients who had an NDE were generally more spiritual and prone to believing in an afterlife; in contrast, patients who had not had an NDE were more likely not believe in the afterlife, and become less interested in spirituality as time progressed.

Van Lommel comments on the marked difference in the kind of experiences described by the subjects who experienced NDEs in his study compared to the kinds produced in studies where “NDE like” experiences were induced through chemical or other means. He concludes “NDE pushes at the limits of medical ideas about the range of human conscious and the mind brain relationship.”

My thoughts about this study are that once again we see this low percentage of patients who have NDEs, and that the chances of experiencing, or remembering the experience deteriorate with age, but which is it? Are patients who grow older less likely to have an NDE or less likely to remember it? While most researchers on this subject suggest that it is memory related, and some of the data from this study may support that, there are other pieces of data that hint at other possible explanations. I find it interesting that during the course of the 8 years of follow up after their cardiac arrests, patients who had not experienced an NDE had progressively less interest in spirituality. In Aware of Aware, as one of a number of potential explanations for not everyone having NDEs, I discuss the possibility of the spirit dying. Is this what we are seeing in these patients? Are the cares of life suffocating the inner being?

Another finding in the study that is of interest is the fact that women are more likely to experience an NDE than men, in spite of being older. I have often noticed that many churches have a higher proportion of women than men (of course mosques are different, but that is a whole other story). I have pondered this and wandered if there are genetic reasons for women showing a greater predisposition towards spirituality. Historically men have been more likely to be involved in violent struggle, be it wars, or one to one fighting. The most successful would be those who are best at winning, and therefore least able to show compassion. These would be the genes that would most commonly be passed on. I believe that spiritual people are generally more compassionate, and that this data may be evidence that men are either less able to “host” a spirit or less able to sense spiritually. Again, the whole issue of the link between spirituality and genetics is discussed in much greater length in Aware of Aware.

I will review the last prospective study, authored by Sam Parnia himself, in my next post. Hopefully it won’t be too long before I am commenting on the one we are all waiting for…the AWARE study.

Abstract:
BACKGROUND:
Some people report a near-death experience (NDE) after a life-threatening crisis. We aimed to establish the cause of this experience and assess factors that affected its frequency, depth, and content.
METHODS:
In a prospective study, we included 344 consecutive cardiac patients who were successfully resuscitated after cardiac arrest in ten Dutch hospitals. We compared demographic, medical, pharmacological, and psychological data between patients who reported NDE and patients who did not (controls) after resuscitation. In a longitudinal study of life changes after NDE, we compared the groups 2 and 8 years later.
FINDINGS:
62 patients (18%) reported NDE, of whom 41 (12%) described a core experience. Occurrence of the experience was not associated with duration of cardiac arrest or unconsciousness, medication, or fear of death before cardiac arrest. Frequency of NDE was affected by how we defined NDE, the prospective nature of the research in older cardiac patients, age, surviving cardiac arrest in first myocardial infarction, more than one cardiopulmonary resuscitation (CPR) during stay in hospital, previous NDE, and memory problems after prolonged CPR. Depth of the experience was affected by sex, surviving CPR outside hospital, and fear before cardiac arrest. Significantly more patients who had an NDE, especially a deep experience, died within 30 days of CPR (p<0.0001). The process of transformation after NDE took several years, and differed from those of patients who survived cardiac arrest without NDE.
INTERPRETATION:
We do not know why so few cardiac patients report NDE after CPR, although age plays a part. With a purely physiological explanation such as cerebral anoxia for the experience, most patients who have been clinically dead should report one.