AwareofAware

Evolving news on the science, writing and thinking about Near Death Experiences (NDEs)

Archive for the tag “Aware study results”

NDE, RED, REX – is it all just a case of Timantics?

Apologies for the pun, but couldn’t help myself. As some of you may be aware one of the more valued members of this site, Tim, and I had a somewhat acrimonious discussion yesterday that became personal and resulted in Tim saying his goodbyes. Goodbyes, unlike death, can be reversible, so hopefully we will see him again and continue to learn from his outstanding knowledge of this subject.

So what was all the fuss about? For me it was a case of semantics – in this instance the meaning of the word death and its use in the term RED. The reason for us discussing what the word death means was due to this article:

Studying death and near-death experiences requires neuroscientific expertise

First of all, the title is ludicrous and based on a huge assumption. The study of NDEs only requires neuroscientific expertise if NDEs are the result of neurological processes. I have spent the past 4 years of my life working in neuroscience, and I can assure you that there is nothing in human understanding of neuroscience that could explain a genuine OBE. That has and always will be the issue, therefore the study of NDEs does not need an expertise in neuroscience. It might benefit from it to interpret various neurological measurements that are acquired during a CA, but it is not necessary, especially when it comes to any experiments that attempt to validate OBEs. If you have a scientifically validated OBE, then that cannot be explained by science. Moreover, neurologists and neuroscientists were a part of developing the consensus statement.

Obviously starting off with the assumption that an NDE is a natural neurological phenomenon means that the rest of the article is constrained by this materialist assumption and therefore many other things that are said are just incorrect. However, there are a couple of points they make that are very pertinent and worth highlighting, and one in particular that caused the spat between Tim and me. It was my suggestion that I agreed in part with their statement about the use of term RED that set things off. This is what they said:

Second, contrary to what Parnia et al. write, people who recall NDEs are therefore inherently people who have not been dead and have not met brain death criteria. Since the introduction of brain death criteria in 50 the 1960s, not a single patient properly diagnosed as brain dead has come back to life….Because of these scientific inaccuracies, the proposed term “recalled experience of death” is wrong and we firmly reject it. The authors confuse “death” with the process of dying

My initial response of agreeing in part was more a gut reaction given that I was not aware of there being specific definitions for death and therefore given this state of affairs, and given the potentially reversible nature of the condition people are in when their hearts and brains have stopped functioning, stating these people had experienced death seemed a bit of an over reach. This gut reaction is reinforced by having watched all these TV shows in which the ER physician announces “time of death” when they give up CPR…i.e. the person is beyond medical help and the process of dying has become irreversible.

As the discussion continued I started looking into definitions of the word death. Dictionaries and on line resources tend to use the word irreversible, but what really nailed it for me was the UDDA definition which is used in the US:

The Commission ultimately recommended a Uniform Determination of Death Act (UDDA) which aimed to make the total brain standard into law in the states. This recommendation has been adopted by the American Bar Association and American Medical Association, and made into law in some form in all 50 states. The UDDA simply states: ’An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead. Sarbey B. Definitions of death: brain death and what matters in a person. J Law Biosci. 2016 Nov 20;3(3):743-752. doi: 10.1093/jlb/lsw054. PMID: 28852554; PMCID: PMC5570697

In Canada: Death occurs when there is permanent loss of capacity for consciousness and loss of all brainstem functions .  This may result from permanent cessation of circulation and/or after catastrophic brain injury. In the context of death determination, permanent refers to loss of function that cannot resume spontaneously and will not be restored through intervention.

Now while this is adopted in the US and Canada, it is by no means globally adopted, and there is still uncertainty about the exact moment that the word death is appropriate, as evidenced in this NHS presentation on the subject: http://odt.nhs.uk/pdf/Diagnosis_of_death.pdf

For me the key quote in that discussion is the following:

Dying is a process; Death is a defined point in that process

This is the point that the article by Martial is making, and while it is a semantic point, it is central to the consensus paper and Martial is right to call them out for coming up with the term RED – recalled experiences of DEATH. Basically, using the dictionary, US legal, Canadian and wider medical community’s definition of death, someone who has achieved ROSC has not experienced death. Oops.

Now I understand why Parnia et al came up with the term, and I somewhat agreed with it in principal at the time, but my view has now changed, and I think theirs should too…although that is harder as they might need to retract their paper which is a pretty hideous thing to do from a researcher perspective. NDE is actually the most accurate term, and while it has been abused by people broadening its application from the one originally intended, it would be better to apply clarifications such as authentic, or classical, rather than completely discard it. In fact their recent attempt to completely change the meaning of the term NDE to not include REDs was something that I really objected to.

But it is all just semantics. Fundamentally, while the term RED is technically wrong, we know exactly what condition they are describing: it is a condition in which the body is completely incapable of consciousness and in which the brain is incapable of producing or storing conscious recollections, and yet people report experiences occurring and have been able to “prove” these through human verification. This is why I say I partly agree with Martial et al say, because otherwise much of way they say is complete hogwash. For instance:

There is hence no “recalled experience of death”; if anything, it should be ‘recalled experience of what might have been the start of the dying process just before consciousness was lost’.

Technically they might right in saying that it could be the start of the dying process, but by adding “just before consciousness was lost” they are betraying their materialist bias. That is an assumption, and the whole point of doing these studies. While they have a point in saying that studies have failed to empirically prove [beyond any doubt] that “people are able to report actual (real-life) events and details happening during e.g., cardiopulmonary resuscitation” neither do these studies, or any others disprove it. Moreover studies such as AWARE I and others, while not providing slam dunk proof, provide very strong evidence supporting the thousands of reports by very credible people, including Health Care Professionals, outside of the context of a clinical study.

Their third point is another tricky one and I find myself agreeing with a part of it:

“Third, the authors write that NDEs in post-cardiac arrest patients fundamentally differ from NDEs made in other life-threatening or non-life-threatening situations, and that the latter experiences are “mislabeled”. Again, the reasoning is flawed. There are no empirical data so far to indicate that the phenomenology of NDE differs in situations that are (a) associated with a threat to life and impaired brain physiology such as  a cardiac arrest, (b) associated with a threat to life but unimpaired brain physiology such as a near-miss traffic accident, and (c) associated with non-life-threatening situations such as drug consumption or  meditation. To the contrary, the data that do exist indicate that all these experiences are phenomenologically  similar (e.g.,12-16). In other words, from the phenomenology of the experience one cannot tell if what happened was a cardiac arrest or e.g., use of a psychedelic drug. Contrary to what the authors state, this similarity suggests that the brain mechanisms behind these experiences are probably also similar, if not identical.”

I agree somewhat with their stating that some aspects of NDEs overlap with other experiences reported in different states. However, there are two ways of looking at this. The first, and one they cite, is that these experiences are the result of similar neurological processes, and the second that these experiences are possible in a variety of states and speak to the ability of the human consciousness to momentarily detach from the physical body. Both, in the absence of scientific, or empirical evidence, are possible explanations, but Martial et al only countenance one, and this is neither objective nor scientific. Moreover, the different conditions they cite are unlikely to produce similar neurological states and therefore it is unlikely they would produce similar psychological outcomes or recollections.

They make a few other statements based on their assumption that NDEs are the result of physiological process, which must be viewed in the light of this unscientific bias. However there is one statement they make that I absolutely 100% agree with, and which has troubled me enormously, and which I have commented on myself previously in this blog.

“Although Parnia et al. question the existence of distressing NDEs which they consider “related to [intensive care unit] delirium, delusions, and dreams in response to toxic metabolic states and withdrawal states (e.g., alcohol withdrawal)” (p. 17 of 127 File S2 from1), the latter claim is not empirically supported.”

The paper that Parnia cites to make this assertion actually suggests the complete opposite. I think this comes from a fundamental flaw in Parnia’s character…he is too nice! He doesn’t even want to consider the idea that people suffer after they die. I get that, but I do not believe that his position is the right one, and explain why in my book.

As for the conclusion of the article:

“Although (near-)death research certainly merits a framework directive, the paper by Parnia et al. is subject to a surprising lack of neuroscientific understanding. It reflects the fact that the field of NDE research (at least in parts) is biased by a widely held belief that there is something fundamentally special, if not supernatural, about NDEs, such as the notion that humans can have conscious experiences in the absence of a functioning brain.”

Yep, that’s the whole point isn’t it, and in the absence of scientific proof that consciousness in the absence of a functioning brain is not present, it should not be discounted as a possibility, and to do so is unscientific. The above statement displays a whopping lack of self-awareness when it comes to understanding their own lack of objectivity.

In summary, I think Parnia et al may need to rethink the use of the term RED. They also need to be aware of their own potential bias, such as on the subject of negative NDEs, and be open to outcomes that might be unappealing, but are nonetheless possible.

You say tomat[e]o, I say toma[re]to – NDE/RED/CPRIC

Thanks again to the eternally vigilant “Z” for spotting this paper which begs the oft repeated question – are NDEs/REDs just another form of CPRIC (CPR induced consciousness)? It is a question that we have answered at length in many past posts but it is important to revisit this due to the context in which it is raised.

While Parnia is not the main author, his influence on it is present, and his work is mentioned and forms part of the analysis. The other authors are from Southmead in Bristol UK, Toronto and Cologne, Germany. Southmead Hospital has a neurology research centre associated with the University of Bristol, and I have been there a fair bit in recent years due to my work in sleep medicine and Alzheimer’s disease (work that has suddenly come to an abrupt end unfortunately due to the vagaries of government regulatory and reimbursement bodies)

https://www.sciencedirect.com/science/article/pii/S2666520422000418

Title of the paper: CPR-related cognitive activity, consciousness, awareness and recall, and its management: A scoping review

At first it seems that they are lumping NDEs/REDs in with CPR induced consciousness. From the intro:

“Two types of cognitive activity and awareness were identified [during CPR]. The first includes visible signs of consciousness such as combativeness, groaning, and eye opening and was referred to as CPR induced consciousness. The second, a perception of lucidity with visual and auditory awareness and recall without external signs of consciousness.”

This is then clarified further in the discussion:

“It could be assumed that pain and distress would be expected in patients showing overt physical signs of con- sciousness through CPR. On the other hand, there have also been cases documented where survivors experiencing more transcendental post cardiac arrest experiences whilst not showing signs of pain or distress have benefited from the experience with it having a positive impact on the patient’s life. When considering treatment options, it may be beneficial to consider these two experiences as two separate entities.”

You reckon!? I suspect that the last sentence was most likely due to Parnia’s influence as a co-author.

All of the key pieces of AWARE data published and presented to date, from I (2014) and II (2019), is included in this review, and therefore, in this paper at least, NDEs are lumped in with CPRIC as events of consciousness that occur DURING CPR – related to CPR. This last point is the most important. Association and causation are two different things, and while the first type of experience, where there are physical signs of consciousness, are undoubtedly caused by CPR, the second, RED/NDE type, is only associated in these cases with CPR. The fact that NDEs have been reported outside of the context of CPR further differentiates them from CPRIC, but this is not discussed in the paper, and these types of experience seem to have been put aside for now by Sam Parnia, most likely for very good reasons, possibly to narrow the field of research to experiences that occur in strictly defined situations with scientifically measurable outcomes.

However, despite the fact that the paper does concede that NDE type events are only associated with periods during which CPR is being conducted, you can guarantee skeptics will cite this paper as further evidence that REDs are due to physiological reasons, and nothing else.

As an aside, having lived on both sides of the pond, I can attest to the fact that you really do need to get your pronunciation of the word describing the small round red vegetable correct to be understood. I remember asking a stewardess on a flight to Ottawa for a can of tomato juice, and being a recent arrival to North America, I was still saying Toma[re]to…and despite repeating it 3 times she had no idea what I was saying. It was very strange indeed, I might as well have been asking for a football, it seemed impossible for her to make the connection between the word I was saying and the numerous cans of the substance she had right in front of her on her trolley. It was only when I said Tomat[e]o that she understood. From that point on I reluctantly adopted the local dialect when it came to certain words, particularly important due to the fact that at the time I was smoking and working in HIV (English smokers will know exactly what I am referring to!) Having returned to the UK I have managed to revert back to the mother tongue, except for the word loo…just can’t use it any more, so I still find myself saying washroom! My wife laughs at me for not returning to the British vernacular for the word toilet, despite the fact that she is a Kiwi and therefore has to juggle 3 forms of English in her head. The only concession I make on this is to use the word “bog”, which is another English word to describe toilet, but I generally do not use it other than when I am in a pub with a group of mates, since this word is not deemed polite.

AWARE II: 15% of people had REDs

This is the first time I think that Dr. Parnia has mentioned any specific numbers from the forthcoming and much anticipated publication of data from AWARE II. A nice teaser quote from the UK Telegraph this weekend:

“Dr Parnia said soon-to-be published research will show that around 15 per cent of people who have been resuscitated from a coma after cardiac arrest have a Recalled Experience of Death.”

Daily Telegraph, 7th May 2022. Sarah Knapton, Science Editor

Link to latest AWARE II teaser

(it is behind a paywall, and given it is mostly a summary of the consensus statement and the state of the field, useful and informative to the wider public, but won’t be news to most here – except for the quote I have given)

Of course it is possible that this could be from his other research which from my understanding is a retrospective database analysis of reports they have collected from NYU and other establishments over the years, but I don’t think he would necessarily be able to state such a well defined number since, unlike AWARE II, that work is not a prospective study that looks at incidence of NDE among all those who survive a CA. Moreover, the fact that he has been trailing the publication of AWARE II for months now, would suggest it is from this study.

I think this is very important as I assume that he will be using the new criteria for REDs to differentiate from other experiences. It also significantly increases the chances of a “HIT”…by about 50% in fact. Given the rigour with which his team at NYU are conducting this research, I think that 15% will become the established number…provided the wider survivor cohort is sufficiently large.

I also think it is really important to consider that OBEs have largely been redefined as EVAs (external visual awareness), which by their very definition require VISUAL recollections. For a long time here we have been discussing the possibility of auditory OBEs , but in the consensus paper these are only mentioned in the context of accompanying an EVA and not a significant phenomenon in its own right.

There are some good NDEs in the comments section of the telegraph article, including one from a chap who had 3 CAs but only produced a single RED. This has been reported before on numerous occasions and points to Dr Parnia’s assertion that most, if not all, people who die and are resuscitated have an NDE (not a RED), but most can’t recall them due to physiological and/or biochemical reasons (which is why they aren’t REDs). This undermines one of the theories I state in my book, which I would be very happy to see undermined as it is not all that pleasant!!

Reminder in the link of my book which I recently updated (available amazon globally). I will be writing another update post AWARE II publication which, in addition to analysis of the new data, will include adjustments and additions to the possible theories as to why 80-90% can’t recall their NDE. This will reflect some of the excellent analysis provided on this topic in the consensus paper.

Link to my book on the AWARE studies

Really good to see the MSM, particularly a respected broadsheet like The Telegraph, take this seriously and report it in a balanced objective manner.

Answer to Oxygen levels and OBE report question – sort of

The second video on the page in the link below is a recording of Grand Rounds from March 2020, which for some reason, I had missed until recently.

Link to videos from Parnia lab

This video should be compulsory viewing for anyone who is interested in a scientific overview of NDEs, the AWARE studies and the work of the Parnia lab. It really highlights to me how amazing Sam Parnia is in terms of his persistence, his thoroughness, his balance, and his humanity in his approach to this subject. Lot’s of amazing tidbits in this video, including anecdotal accounts of NDEs, some discussion around explanations (or lack of) for consciousness and the philosophy of it all. Remember, this is in the context of Grand Rounds at one of the world’s leading hospitals…not a meeting of your local chapter of IANDS. This is one of the world’s leading scientists on the science of consciousness during “death” speaking to fellow physicians and scientists.

Anyway, the reason I made a post about it is that I get an answer to a question that has been bugging me for ages, namely the link between R02 (blood oxygen in the brain as measured by brain oximetry) and episodes of conscious recollection. I have repeatedly tried to get some comment from Dr Parnia or one of his research colleagues on whether any of the reports of sufficient oxygen levels to potentially experience consciousness were correlated with reports of auditory OBEs or other conscious recollections, or not. In this video, at about 50 mins, one of the attendees at rounds asks a similar question, and Dr Parnia replies that there is currently insufficient data to comment on that. That’s why it is only sort of an answer.

This was a year ago. It’s hard to assess how much impact COVID has had on AWARE II, but if they were going by their original study plan, they would have completed recruitment by now and be writing it up. Hopefully we won’t have too long to wait before we receive a full read out from this study.

Time of death…

Partly due to the fact that the last post has nearly 300 comments and so it is good to start a fresh post, and partly because this really disturbing case study raises a question that is very relevant to the whole subject of NDEs, and therefore worth a discussion all of its own, I am posting this and asking the usual contributors and any new ones, to answer the question…”when are you actually dead?” And also what does this highly unusual case say about the relationship between consciousness and physical death, and NDEs in general:

Patient who remained conscious after heart stopped

“The authors conclude that the high level of patient awareness plus oxygen saturation and arterial gas being almost within the normal range throughout the 90 minutes of treatment indicate that peripheral and cerebral blood flow was good and the chest compressions were highly effective. They note that that even though the patient had a poor prognosis, the termination of CPR after 90 minutes raised ethical questions in the team as the individual was still conscious at the time.”

My thoughts, (the horror of the situation aside):

1. In the overwhelming majority of cases when the heart stops, normal “waking” consciousness is immediately lost. This is proven by the immediate and almost total loss of brain activity as measured by EEG. Prior to modern CPR this was historically defined as the point of death. This is why Dr Parnia refers to NDEs as ADEs…actual death experiences. In other words the patient is technically dead. In this case, the EEG probably showed activity associated with normal levels, although this is not mentioned. The patient experienced heart death but not brain death.

2. Death is a process, and as has been mentioned before, none more so than by Parnia himself, it is reversible, and using various methods, the point at which it can be fully reversed without any long term damage can be stretched beyond the several minutes mark. To me true physical death is the point past this. It is the point at which the cells have endured so much damage that the body, and especially the brain, is no longer able to function properly.

3. This case contradicts something that I had always thought was absolutely true…when the heart stops the conscious either shuts down completely, or starts to “detach itself” from the host as we believe is the case with NDEs. However, it appears that if CPR is immediate, and continuous blood flow is kept going, the conscious can somehow “be fooled” into believing that “its host” hasn’t died. What do these cases say about the nature of the connection between body and conscious? And for the skeptic do cases like this provide evidence against NDEs?

Brand New Findings Revealed?

Thanks to Eduardo for picking this one up. I am extremely busy at the moment so don’t always have the time to trawl the networks for anything Parnia or NDE related, so appreciate when others email me links or post them in discussions. I felt this was worth pulling out. It was aired earlier this week on Dr Oz on January 22nd 2018. Dr Oz opens the segment with the announcement that brand new findings are going to be revealed (in the show). He then introduces Dr Parnia…well have a look yourself, click on the picture of our favorite intensive care doctor to access the video:

Parnia

Is this a sleight of hand or is there actually new data, or “brand new findings”?

Dr Parnia on one hand seems to describe the design of the most recent iteration of AWARE, AWARE II, then slips in “we did a study…” talking about the results from AWARE I. Given that he categorically stated in emails and on his Twitter feed that the results from AWARE II won’t be made public until after the study is finished in 2020, and that at this stage they have only recruited 350 or so, one can only assume that he is referring to AWARE I. However, the confidence he has in the assertions he makes seem to be growing stronger, which makes me believe that AWARE II has got some verified hits. AWARE I did not have any properly confirmed OBEs (i.e. validated sightings of pictures). There were some interesting accounts, and without doubt some real NDEs, and OBEs, but without the visual confirmation, they are nothing more than has been reported from countless other studies or independent accounts.

I do wonder why he is doing this. Is it to plug his book (Dr Oz does that at the end of the segment)? On some days he seems keen to protect the integrity of the study by not disclosing any preliminary results, but on others he does this kind of stuff. I guess there’s nothing specifically wrong with it, but from my perspective as a scientist, I do find the hyperbole attached to this format of show to be distracting and potentially tainting the credibility of the research, especially when the headlines do not match the reality. From what I can see there are no new major findings presented in this show.

As I say above, I can only assume that he is so confident now in producing paradigm shifting results, that he knows that in the long term, this will not cause any damage.

Update on status of AWARE II

Just a quick update on the AWARE study. I recently contacted the study team, and they informed me that the study opened and began recruiting on May 1st 2015. I asked for an updated protocol, but they are being a bit cagey about specifics at the moment, which is pretty understandable (if the exact details were known to outsiders it would be easier to discredit any positive results). What info we do have is available on the UK research website link below. The study is anticipated to run for 2 years. As I have stated before, I have concerns about the exclusion criteria not being broad enough, and that potentially we could see a repeat of AWARE I in which they recruited over 2000 Cardiac Arrests, but only a small minority of these were relevant in terms of providing data. In my view, unless they only include all CA survivors who had the crash cart plus LCD monitors in attendance and were able to complete a post event interview, then they should not be included.

Hopefully they have considered this and are proceeding in a more focused way with their new protocol.

AWARE II study

Finally, I know people come here from to time, and are disappointed that new posts are few and far between. As I have explained before, I have a very busy job in research, in addition I write novels in my spare time and this has been the primary focus of my energy of late. I will however attempt to post more thoughts and comments on NDE research as time goes by so sign up for updates so you will be notified when these appear.

AWARE Study II methodology: If the mountain won’t come to Mohammed…

Firstly I would like to thank Peter for contacting me and alerting me to the fact that the design of the second phase of the AWARE study is now available on the UK clinical Research Network website.

This is obviously great news, and shows that this important research is going forward and that at some point in the future more data will emerge on attempts to capture an NDE using robust methods. This last point is certainly something that seems to have been addressed in the new design of the study. If you have read my previous posts, you will have noted that I pointed out the statistical problems facing the investigators, namely that due to the fact that only a small proportion of people survive a Cardiac Arrest (CA), and of those only 10% claim to have had any type of NDE, and of those only about 25% report an Out Of Body Experience, the numbers you would need to enroll into a study to validate an OBE would be huge. This problem is amplified by the fact that in the original AWARE study less than half the subjects actually had CAs in areas with validating images, so even if someone reported an NDE with an OBE, their chances of seeing the image were extremely low. I suggested that they either set up a huge study to insure enrolling enough patients to sufficiently power the research, or they increase the number of cards with images on, and choose areas where CAs are most likely.

The solution that has been arrived at is outlined in the design of AWARE II:

Emergency Department or Research staff will be alerted to cardiac arrest and will attend with portable brain oxygen monitoring devices and a tablet which will display visual images upwards above the patient as resuscitation is taking place. Measurements obtained during cardiac arrest will be used to compare data from all cardiac arrest patients independent of outcome [whether they live or die]. Survivors will then be followed up and with their consent will have in-depth, audio recorded interviews.

This is the Mohammed going to the mountain solution, and has real potential to overcome many of the problems encountered in the first study. This way, and I am making an assumption here, only CAs where this research team actually arrive and are able to get the tablet in place will be included in the study. This instantly erases the problem of having sufficient rooms with images to insure capturing an OBE. It does not however overcome the problem of whether or not the person experiences their OBE from the perspective of being directly above themselves. While this is common, it is not the universal “pop out position” that subjects report, therefore we may get a frustrating account of someone having an OBE standing in the corner and reporting someone holding a tablet above them. Also, I can imagine there will have to be a considerable amount of training involved for the researchers and also a great deal of co-operation from resuscitation teams whose immediate priority is reviving the patient. However, this new method does have significant advantages over those used in the first study, and therefore should have a higher chance of validating an OBE without recruiting tens of thousands of patients..

The study is aiming to enroll 900-1500 subjects by the end of MAY 2016 at the latest, and will be a multi-center international study like AWARE. I wish the investigators the best of luck in their endeavor to validate NDEs and OBEs, and I would like to commend Dr. Parnia and his co-investigators for their ingenuity and tenacity.

Finally, with regard to this blog, I will be starting a new project on these pages related to this subject area in the New Year, and will of course continue to add any emerging data or news on research in this field.

Phase II of the AWARE study announced

There was me thinking I’d wasted an awful lot of time writing a book and creating a website that had its focus of interest on the AWARE study, which appeared to be completed following the recent publication of results, when in fact the fun has only just begun. Today I received an email from the Horizon Research Foundation, one of the organizations that provided funding for the original study (link to site at bottom of post), stating that phase II had begun in the UK. This is obviously very exciting news, not least because this website now has a reason to continue to exist! In all seriousness, Dr. Parnia had told me in our recent exchange that they were looking at various options. It will be interesting to see if he is still the lead investigator given that he is now based on Long Island, NY…I will endeavor to find out.

As I mentioned in my previous post, which describes the kind of barriers I suspect that they are up against, they will need to aim to include at least 10,000 Cardiac Arrests to have any chance of a scientifically validated OBE. This is due to the fact that not many survive, and of those that do, a significant proportion would be excluded from further analysis. To boost their chances of success they should focus on areas of the hospital which had the highest incidence of CA in the first AWARE study, and increase the number of targets in these areas.

Another consideration, if they didn’t do this in the original study, would be to introduce an element of “blinding” (a term used to describe techniques of research that insure that investigators and subjects are unaware of whether an active intervention is being administered or not). This could be achieved  by insuring that the post CA interviewers were unaware of the content of the pictures in the target areas.

Finally I would like to wish the AWARE study team good luck in their noble quest to continue researching this most important of areas. The results from AWARE phase I, as well as shedding light on the difficulties of performing high quality scientific research on NDEs, have also validated the incidence of NDE (~10% of survivors) and OBE (~25% of NDEs) from earlier studies. This, along with the semi-validated OBE from AWARE I, provides further circumstantial evidence of the validity of these phenomena…my hope is that it will not to be long before this group, or others, provide incontrovertible evidence. If they do, you can be sure you will hear about it here. In the mean time I will continue to examine the implications of other emerging research on NDEs, and post any relevant insights from time to time on this blog.

 

aware logo

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.

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