AwareofAware

The Fat Lady Sings…or not.

I contacted Dr. Parnia this week to find out the fate of the AWARE study, not least because I wanted to know if there was still a possibility of proving my hypothesis or not, and this was part of his response:

“The plan is to use different resources to continue research into the areas explored during the AWARE study. As with any research endeavor one study raises questions and [opens] new avenues for further research, and AWARE is no different. The details will need to be worked out. However, I think the AWARE results have opened new areas for exploration for ourselves and others in the field. I am sorry that we cannot discuss this in more detail however we hope there will be new studies generated in the coming years.”

My understanding of this is that the AWARE study is complete, and the results published last week in Resuscitation are the final results from this study. However, this does not appear to be the end of the story, and it seems that new studies may be undertaken, using the experience the investigators gained from AWARE, to gain further insight into NDEs and hopefully one day validate OBEs.

So where does this leave my hypothesis. Just to remind you:

“Even if the AWARE study only has one or two verified OBEs, then this will prove the existence of the soul.”

Given that the AWARE study produced no scientifically validated OBEs (a subject seeing a card), you might be inclined to think that my hypothesis had been disproven, however, that would be wrong. Having now fully digested the results from the study, I have come to realize that my hypothesis was based on some very important false assumptions about the powering of AWARE.

When I originally made the hypothesis, it was based on my understanding of the study design as initially presented back in 2008. The specifics of the design were quite vague, but the wording was something along the lines of “data from about 1000 or more Cardiac Arrests (CA) would be used”. I took this to mean that there would be a 1000 or more surviving cases eligible for inclusion; that all these survivors were interviewed; and that all had the potential to see the pictures on the shelves. Using this base number of a thousand, and the fact that only 10% of survivors have an NDE, and only about 25% of those have an OBE (2.5% overall rate of OBEs), and that although the shelves might be in the room, they might not be in the right place, or the patient might not notice, or they might not remember (I reckoned about 10% of OBEs would recall seeing it), I predicted that a very small number, maybe even only a couple of those original 1000 would see the card. In other words, my hypothesis might have been more accurate if I had stated it thus:

“Given the rareness (~2.5%) of reported OBEs in subjects surviving CA, and the study’s limitations with regard to ability to insure that validation cards are reported by these subjects, the AWARE study would only need to produce an incidence of validated OBEs of 0.25% to prove the existence of NDEs.” (the 0.25% comes from my estimation that only a couple of survivors out of about 1000 would validate).

There were two assumptions that I made that were false:

1. There would be 1000 CA survivors who were eligible for inclusion and were interviewed.
2. All of these would be in rooms or areas with validation cards.

The reality:

1. In spite of there being 2060 CAs, there were only 330 survivors, and of these only 101 were included in the final analysis who were both eligible and who completed the requisite interviews.
2. Only 22% of all CAs took place in areas with validation cards…this point is exemplified by the fact that neither of the 2 subjects who reported OBEs were in one of these areas.

Two of the other assumptions I made were correct:

1. About 10% of CA survivors report an NDE (9)
2. 25% of people reporting an NDE report an OBE (2)

The “other” assumptions were conjecture (these basically reduce the chances of seeing and recalling a card by about 90%). However, if I had used the more accurately stated version of my hypothesis that I quote above, namely that only 0.25% of subjects who survive a CA, who were: eligible for inclusion; had been interviewed; AND who were in areas with a validation card, then this study would only produce 0.055 (0.0025 X 22) validated OBEs.

In other words, given the results as presented in the paper, and my additional assumptions about the ability of patients to see or recall validation cards if they were in the right areas, then this study only had a 1 in 18 chance of producing 1 solitary validated OBE (1/0.055). That translates to a 6% chance of this study producing a positive result.

Let’s be very generous and just drop my “other” assumptions for a moment, and instead assume that all patients who survived a CA, completed an interview and were in areas with a validation card (this would be about 22 patients – 101 X 22%) were able to see and recall that card if they had an OBE (which is about 2.5% of CA survivors according to previous studies, and indeed this study). That would mean that this study would produce 0.55 (22 X .025) subjects with a scientifically validated OBE.

To summarize the math, given the number of eligible subjects who were in areas with validation cards, and being incredibly generous with regard to the ability of these subjects to see and recall these cards if they had an OBE, at the start of this study, there was a 1 in 2 chance of producing only 1 validated OBE. Given the fact that we now know that the 2 OBEs occurred in areas without cards, the study in fact had no chance at all of producing a positive result. Ultimately this study was hopelessly underpowered (I explain powering in a previous post and in my book).

It would be easy to blame the investigators for not designing the study better, and in the first version of my book I was indeed a little harsh in this respect. However, this was the first large study of this kind, so they are allowed to be less than perfect, but more importantly, it’s hard to see, even with hindsight, how you could significantly improve the odds of insuring that all NDEs occurred in areas with the cards, and having a sufficient number of subjects who were eligible.

Going forward, if Dr. Parnia and/or other investigators are proceeding with this research, then they might want to consider the following suggestions:

• Go over all the data from the AWARE study and identify the areas, across different hospitals, with the highest incidence of CAs
• Recruit more centers (or run the study for longer, with the goal of recruiting sufficient eligible survivors), and place the validation cards, or some improved validation method, in these high incidence areas only
• Maybe have more than just one validation card in each of these areas to overcome the problems I included in my other assumptions

If a study was undertaken that placed cards in areas in such a manner that 50% of all CAs took place in a validation zone (instead of just 22%), and there were sufficient cards to insure that the chances of a patient not seeing the cards were much reduced, perhaps increasing the odds of someone who has an OBE seeing and recalling the cards from about 10% (my original assumption), to a figure close to 33%, then the chances of success would be much higher, but don’t hold your breath, this ain’t gonna happen tomorrow.

In the instance that a study was designed in just such a way as to meet these criteria, then using the numbers of patients from this study who had a CA and who were eligible and interviewed 101/2060 (5%), you would need to aim to run the study for long enough to include 10,000 CAs to have a chance of capturing just 2 scientifically validated OBEs (10,000 X 50% (% CAs in validation area) X 5% (% who survived + eligible + interviewed) X 10% (% subjects who had NDE) X 25% (% of NDEs with OBE) X 33% (% who saw and remembered the card)).

10,000 Dr. Parnia! I hope you are more patient than me, either that or you are able to motivate a small army of researchers willing to take part.

Finally, I just want to restate that my hypothesis has not been disproven, and I would like to refine the wording, using the same underlying principles, in the following manner using correct assumptions:

“In the instance that a sufficiently well powered and designed study records post CA interviews with eligible CA survivors in areas equipped to validate OBEs, then an incidence rate of validated OBE of ~1% among these survivors would prove that NDEs are real. In other words, in a study that aimed to recruit 10,000 CAs, which produced 250 eligible survivors, only 2-3 would be needed to prove NDEs are real, and by inference, that the soul exists.”

Given that we are obviously only at the beginning of this journey, and relying on a renewed surge of energy from the admirable Dr. Parnia and his colleagues for this journey to even continue, I will keep posting on this blog, because even though the AWARE study might be over, this area of research and the subject of NDEs is far from dead.