AwareofAware

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

Archive for the tag “NDE”

Brainless materialism

Apologies for the long gap between posts, but I am still working on a new book that I will be publishing later this year. Anyway, this article really caught my attention:

Science and the Soul

“But I was wrong. Katie made me face my misunderstanding. She was a whole person. The child in my office was not mapped in any meaningful way to the scan of her brain or the diagram in my neuroanatomy textbook. The roadmap got it wrong.”

This a quote in which the neuroscientist discusses the relationship between the brain and the soul, or self. He claims that the brain is not the source of the mind or the soul, and cites findings from interesting experiments performed over the years that support this thesis. He concludes the following:

“There is a part of Katie’s mind that is not her brain. She is more than that. She can reason and she can choose. There is a part of her that is immaterial – the part that Sperry couldn’t split, that Penfield couldn’t reach, and that Libet couldn’t find with his electrodes. There is a part of Katie that didn’t show up on those CAT scans when she was born.

Katie, like you and me, has a soul.”

This is of course central to the whole understanding of what is going on with an NDE. Just as it should not be possible for a child to have a full range of mental skills when she has been born with a fraction of a functioning brain, so too should it not be possible to experience consciousness when the brain is technically dead, or at the very least “unalive”. Both of these phenomenon are incompatible with a materialistic understanding of human consciousness, and point to the soul being a separate entity, entirely independent of the brain for its existence.

The issue in this type of case where a significant part of the brain is missing or not working properly, is that if the mind is entirely a product of the physical functioning of the brain, then any significant reduction in brain capacity should correspondingly reduce the mind’s capacity. Classically speaking, various parts of the brain have been shown to be responsible for various cognitive functions through brain imaging experiments, and yet when those parts are damaged or destroyed, or not present in the first place, then it seems that other parts sometimes pick up the slack. This completely negates the idea that the mind is a mechanical product of the brain since the relationship between the brain and the mind must therefore be somewhat abstract. This points to the metaphysical nature of the soul/mind/conscious.

When you look at the brain as just being a host organ for the mind, then the observations from the ER and the neurology journals start to make sense. If the mind, or soul, is a whole independent entity, it would be able to occupy and communicate with the brain, even if the brain is reduced in its capacity. The soul is not reliant on the brain for its existence. This is of course the conclusion from NDEs, where the brain is “unalive”, to be technically correct, and yet the soul/mind/conscious persists. These two findings which have been replicated numerous times are mutually supportive of the understanding that the soul is not a product of brain activity.

 

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.

Early results from AWARE II?

Thanks Eduardo for sending the link to this article last night.

The article starts out moderately interesting, discussing the case of one woman’s NDE thirty years ago, then mentioning Jeffrey Long’s database, and Eben Alexander. Then it moves to our favourite NDE researcher, Dr Sam Parnia. Of course our interests are piqued, then our eyes pop out at this bombshell:

“Parnia is in the midst of working on a follow-up study, called AWARE II, with a public announcement likely in the next six months.”

So I have mentioned in past posts that the study is planned to finish recruitment in 2020. However, those who are close followers of this blog, and the comments sections (which are often more interesting than the posts as they contain some excellent observations etc from fellow NDE “nerds”), will have noted that I have often said if there were two or more verifiable hits (i.e. fully documented NDEs with confirmed OBEs – namely the subject seeing the image on the LCD screen), prior to complete recruitment, then I suspect Dr. Parnia would go public.

Could this be what that announcement will be about? Of course, we will not know until it is actually announced, but if it is, then this will be the event we have all been waiting for ever since AWARE I was first mentioned way back in the mid noughties. This will be the moment we see a permanent paradigm shift in scientific thinking, and methodological materialism will be dead.

I am very hopeful. I noted last year that there was suddenly a big upsurge in activity from the AWARE study team. At the same time, they stopped communicating with external sources like myself. At the time I speculated that they had one hit, and they were ramping up activity to get another, whilst insuring the integrity of the study by keeping any new data strictly under wraps.

Also, of interest in the article are the comments made about the whole 10 percent issue. Dr Parnia appears to have created a part of the questionnaire that picks up subconscious recollections from the resuscitation:

“For instance, in some cases people who appear unconscious are given names of cities and objects,” he says. “When they have recovered they have been asked to recall any memories. Even though they have no recall, when asked to ‘randomly’ think of cities, those who had been exposed to the stimuli are statistically more likely to choose the same cities compared to control subjects. Thus indicating they had heard it.” 

Aside from the rather bizarre thought of nurses and doctors randomly shouting “Mogadishu” between “charge the paddles” and “clear”, this could provide some very interesting insights into whether the fact only 10 percent recall an NDE is memory related or otherwise, the topic of the previous post(s).

While this is very important, I am hoping that the announcement will relate to verified OBEs.

Dr Parnia, you have us all on tenterhooks!

Link to article: AOL article on NDEs

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.

Why Do We See a Decline In Reports Of NDEs With Age?

Over the past month I have summarized the key findings from the 3 main prospective studies looking into NDEs that all reported their results in the early 2000s. Since then there have been no large trials of this kind reporting in major medical journals – the research has reached a point where using the methods of the time, no more results of genuine academic interest will be discovered. The Parnia pilot study, like all the others, had established that NDEs were relatively rare (about 10%) and that there would need to be a very large number of Cardiac Arrest (CA) survivors to produce a “proven” out of body experience (OBE), the ultimate scientific result. Dr. Parnia and his team of co-investigators set up the AWARE study in 2008, with the objective of recruiting just such a high number in the hope of discovering this “smoking gun”.

If the NDE is real, and the OBE is a real element of NDEs, then it is inevitable that one day the AWARE study will produce one or more proven OBEs, and that afterwards more studies will produce an increasing number of similar results. This is the baseline that I assume in the book Aware of Aware, because for me, someone who has always believed in the existence of the soul, and having encountered credible people who have told me about their NDEs (usually reluctantly), this result is not the most interesting that can come out of this area of research. It is a bit like when man first went into outer space, or reached a high enough altitude to notice the curvature of the earth, the observation that the earth was not flat was not a surprise. So it is with believers in NDEs, a proven OBE will only tell us what we already knew. However, for the large numbers who don’t believe that NDEs are real or that the soul exists, this piece of evidence is crucial, and in my view has the potential to be the most important scientific finding ever as it will end the materialistic view that modern man has developed of life and his own existence.

For me, one of the most interesting findings from NDE studies is the correlation between age at the time of CA and reporting an NDE. The most common and palatable explanation for this is that the ability to report declines with age due to loss of memory function. This seems like an acceptable hypothesis until you look into it in a bit more detail.

Firstly, it is just a hypothesis. None of the three studies performed prospective investigations to link memory function with reporting an NDE – (there were no differences in psychological factors between experiencers and non-experiencers). To link memory directly to reporting an NDE would require adding a comprehensive memory test, or questionnaire, to the interviews that were conducted.

Personally, I am not convinced about the lack of NDEs in older patients being memory related. The first reason for this is the huge difference between reports of NDEs in the young (especially pre-adolescent) and old, with younger patients having an incidence of more than 50%. Whilst memory function does decline with age, older people do still report NDEs, so it is not the fact that a younger brain has a unique ability to remember this kind of experience. Nor can age-related decline in function account for such a huge disparity. Unless a patient has Alzheimer’s, older people do still remember dreams and recent events, maybe not quite so well, but the differences of reported events would require a decline of function many orders of magnitude higher than is generally the case.

Another very interesting piece of data that comes out of the Van Lommel study is the fact that women are more likely to have an NDE than men. In the Dutch study the overall incidence of reported NDE is 12%, however with women it is 21% (p=0.011 – p values relate to statistical significance; in general a p value lower than 0.05 is considered statistically significant as there is less than a 1 in 20 chance that this outcome could have occurred randomly). The fact that women were on average 5 years older, is also directly relevant to this discussion (mean age for men 61 vs 66 for women).

To put this result into the context of the issue of memory being the driving factor behind age related differences in reporting of NDEs, for this to be true, a 61 year old man would have to be nearly twice as likely to have severe memory problems as a 66 year old woman. This doesn’t ring true, and there is nothing in the literature to support this. There was some recent data to suggest minor differences between sexes with regard to reported changes in memory (in the HUNT3 study, Holmen et al. reported that 1.2% of women and 1.6% of men, aged 30-89, reported severe memory problems, changing to 0.9 vs 1.5% age range 60-69), but this does not account for the differences in reported NDE. Incidentally this study also showed that there was little difference in reports of severe memory problems between younger and older patients, however there was an increase in reporting of some minor memory problems as age progressed, but this again would not account for the greater than 5-fold difference between reports of NDEs in young subjects vs old.

So what is going on? For me that is the biggest question of all. If physiological and psychological factors cannot account for age related reduction in reporting of NDEs then maybe there is some other “unscientific” factor. Given that we are entering uncharted territory with regard to science potentially proving the existence of the soul, it should not be surprising that conventional science cannot answer questions regarding the incidence of NDE occurrence.

In Aware of Aware I propose some potential answers as to why it is that we observe these differences in reporting of NDEs, including the potential for Soul Death. Such an idea might be extremely disturbing to some, but to those familiar with various religious texts, this is very familiar.

I have a favor to ask regular readers of this blog. For a short time (till the end of June) I will be making Aware of Aware available at the lowest price Amazon will allow. If you have the time, and want to help me, please could you buy a copy, read the book and then do one of two things:

  1. If you enjoy the book and feel it is relevant to the discussion, post a review on Amazon.
  2. If you don’t enjoy it, please refrain from posting a negative review at this stage, rather, please could you contact me through this site, using the “contact me” link in the header or complete the form below and let me know how I could improve it.

(to buy click on one of the links below to Aware of Aware or search on your local Amazon site in either the kindle or book section – NB: it’s not always on the first page of a search!):

Aware of Aware US Amazon Kindle ($0.99)

Aware of Aware US Amazon Hard Copy (should be $7.63 by end of June 2nd)

I will shortly be updating the book with some of the data that I have been posting here, as well as trying to improve the overall content in any other ways possible, so your suggestions or comments would be very timely.

Cheers!

Last But Not Least

This is the 3rd and final overview in my series of reviews of prospective NDE studies. The last study, A qualitative and quantitative study of the incidence, features and aetiology of near death experiences in cardiac arrest survivors, was published in 2001 in Resuscitation. The author was Dr. Sam Parnia, who is very well known to the readers of this blog. This study was in fact the pilot study for the ongoing AWARE study. (pilot studies are small scale studies designed to identify any issues with technique, and also gain an understanding of numbers that would be required to drive a result from a planned larger study)

The study was conducted at Southampton General Hospital over the course of one year. This was another study that exclusively looked to prospectively recruit Cardiac Arrest (CA) survivors. Patients were interviewed within a week of the event, and any memories that were recorded were assessed using the Greyson scale. The investigators also assessed various physiological parameters such as hypoxia, electrolyte disturbances, drugs, as well as psychological factors such as religion.

This study was the first to prospectively deploy the use of “targets” to verify OBEs (i.e. to prove whether or not they are indeed veridical). Cards with images facing the ceiling were placed above the beds in the resuscitation suite. To quote Dr. Parnia on the use of these images:

“If OBEs are indeed veridical, anybody who claimed to have left their body and be near the ceiling during a resuscitation attempt would be expected to identify those targets. If, however, such perceptions are psychological, then one would not expect the targets to be identified”

This statement is problematic, but it is a moot point in this instance, as I shall explain.

The results of the study can be viewed in the abstract below, but to briefly summarize, out of 63 CAs, only 4 (6.3%) subjects had an NDE by the Greyson scale. There was no difference in psychological or physiological factors between those who experienced an NDE and those that didn’t. There were slightly higher levels of oxygen in the blood of those who experienced an NDE, than those that didn’t, but the numbers were too small to form a conclusive causative association. There were no OBEs reported, not just that no one saw the cards, but that no one even reported an OBE.

Once again, we see very small numbers of CA survivors who either experience, or are able to remember, an NDE. This influenced the eventual design of the AWARE study, with the investigators deciding that there would need to be at least 1000 CA survivors to sufficiently power the study and generate enough cases to form statistically significant conclusions about NDEs. Because there were no reported OBEs by any patients, this study did not inform the team as to how they should progress with the targets.

This last point is important, as I point in my book Aware of Aware, the same card based targets were initially deployed in the AWARE study. This is a relatively limited and crude way of verifying OBEs since not all patients report seeing themselves from directly above. There are other issues that I will not belabor here, but I understand that the targets have been refined and become more sophisticated as the AWARE study has progressed.

So this concludes my mini-series of reviews of the 3 main prospective studies that have been published on NDEs. I will discuss the combined findings and implications in another post, but suffice to say, these studies at once lend credibility to the NDE phenomenon and the area of research, but also leave the most important question unanswered, namely, is the NDE proven to be a genuine transcendental experience in which our conscious separates from us, or is it all just happening in our heads. Personally, I believe that the NDE is the former, and therefore it is logical to conclude that it is only a matter of time before a target is identified (the pretext for the book Aware of Aware). Hopefully it won’t be long before we find out if the AWARE study has indeed achieved this goal.

Abstract:

Aim :To carry out a prospective study of cardiac arrest survivors to understand the qualitative features as well as incidence, and possible aetiology of near death experiences (NDEs) in this group of patients. Method : All survivors of cardiac arrests during a 1 year period were interviewed within a week of their arrest, regarding memories of their unconscious period. Reported memories were assessed by the Greyson NDE Scale. The postulated role of physiological, psychological and transcendental factors were studied. Physiological parameters such as oxygen status were extracted from the medical notes. Patients’ religious convictions were documented in the interviews and hidden targets were used to test the transcendental theories on potential out of body claims. Those with memories were compared to those without memories. Results : 11.1% of 63 survivors reported memories. The majority had NDE features. There appeared to be no differences on all physiological measured parameters apart from partial pressure of oxygen during the arrest which was higher in the NDE group. Conclusions : Memories are rare after resuscitation from cardiac arrest. The majority of those that are reported have features of NDE and are pleasant. The occurrence of NDE during cardiac arrest raises questions about the possible relationship between the mind and the brain. Further large-scale studies are needed to understand the aetiology and true significance of NDE.

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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.

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