AwareofAware

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

The Good, the Bad and the Ugly study

Thanks to Z who has once again done my job and kept a close eye on the literature, and alerted us to this study which was published at the end of last week:

Lapses of the Heart: Frequency and Subjective Salience of Impressions Reported by Patients after Cardiac Arrest

The Good:

This study is possibly the best designed NDE study I have come across. The site in Vienna started out as a site in the AWARE study, they then extended the protocol beyond AWARE creating their own method for validating…or otherwise, OBEs. It is like they read what we suggested as a well designed experiment, ensuring full blinding until the close of the study, and implemented it:

Hidden Images

At an elevated position above one emergency bed (2 m above ground), a notebook PC was fixed facing the ceiling and displaying images selected at random from a pool of 29, switching from the actual to any in the pool every few hours (the number of hours was unpredictable). These images were not disclosed to the public and were not even known to all of us (in particular not to the main interviewer M.L.B.). The presentation history was stored on the PC, and any readout of this history, be it authorized or not, left its trace.

Well done to this team for getting this right.

They also extended the inclusion criteria for possible experiences, allowing for patients who had Greyson scales <7 to be included in the results if they had recollections around the time of CA. This was smart, and I will come back to this in a moment.

So that’s the good.

The Bad:

The results are disappointing. Yet again a low percentage of NDEs, especially using the Greyson scale:

Only 5 of 126 (4%) scored at least 7 points, the criterion to pass as NDE in the strict sense. Under the impression that this instrument may not be sensitive enough to detect experiences associated with a transient shortage of brain oxygen during CA, we included 15 more with detailed recollections from a period near to their CA.

I would say that another 6 (cases E,G,I,K,M and P) had elements of NDEs that we are familiar with, so if you included these 6, you have 11 NDEs from 126 CA survivors, which is very similar to other NDE studies.

There is one OBE, but the subject reported standing next to their body, rather than being above it, and were unable to report the memory of what they saw with any accuracy. There were a couple of other OBE like reports, but were more likely visual distortions etc due to erratic brain activity.

Subject K is highlighted as someone who got them excited:

“She had seen a field with beautiful pink flowers resembling water lilies, all of similar size. In her words, this was the first impression “during waking up” and she added: “It was great that the medical staff was capable to display it for me”. When she saw these flowers, she was sure that she would “return”. For the first (and only) time, we had the suspicion that a patient made reference to one of our hidden images.”

In 2021 when they reviewed the data from the laptop which reported exactly what images were presented at what time, the images that were displayed when she was in CA were nothing like what she described. Some key points here:

  • She had a Greyson score of 1, and most importantly
  • she did not report an OBE.

I will come back to this, since it central to what makes some of their conclusions and discussions downright:

The Ugly:

The paper was authored by Michael L. Berger and Roland Beisteiner. Both are involved in neuroscience research and neurology. While attempting to create a veneer of impartiality they quickly betray their underlying, subjective, predetermined view of OBEs in the introduction:

It may be objected that an experimental approach testing for visual awareness from a point outside the body was futile and misplaced in a serious scientific study, neglecting the generally accepted view that ‘even the most complex psychological processes derive from operations in the brain’ [11]. On the other hand, our certainty about the biological basis of awareness (as about any scientific ‘fact’) is the result of well-controlled experiments and observation, but can never be final and absolute. It has always been the noble privilege of experimental research to put to the test even the most solid dogma, provided the chosen approach was sufficiently well controlled against error and fraud.

In other words they are saying “we know that NDEs and OBEs are caused by neuronal activity, but we are going to do this experiment anyway because this position has not been absolutely and finally proven…although we actually think it has.”

They cite some of the studies we are familiar with, and have debunked here, as evidence for their position. Anyway, given this, you know from the outset they are not going to be objective. It feels very much like they have taken part in this study, are a bit embarrassed about it so put lots of caveats up front, and then completely abandon all objectivity when it comes to their conclusions so their colleagues won’t laugh at them. Shame on them, it is truly fugly.

This is the offensive line referring to subject K:

The image shown during the acute period (CA and post CA, Figure 2) had not the slightest resemblance to the scenery described by the patient. This may be seen as a negative result, but in fact it vindicated the generally accepted view that consciousness depends solely upon brain function.

The hell it does!

Sorry, I know some people don’t like the H word (esepcially Sam Parnia!), but I cannot think of saying this more politely. It is an obscene conflation. To understand why this is the case, you need to read the interview report of subject K:

Due to difficulties in breathing, case K (№ 83), a female 79 years old when the CA occurred, was originally entered as pulmonology patient at the general hospital. The CA happened during her firstnight there. She was successfully resuscitated and transferred to the emergency unit for further treatment. During the interview 83 d later at home, she surprised her husband (who participated) with the revelation that after losing consciousness she had the agreeable impression of a beautiful meadow with wonderful flowers. The flowers were pink and reminded her of water lilies. Was it a dream? No, she prefers the term ‘impression’; she was “pleased that the clinical staff was able to produce it for her”. She likes this memory: “Now I knew: I will come back.” (See Fig. 2) Greyson point: 1

Key points:

  • She did not report an OBE – she did not say she saw herself from above, or beside her body. She did not report seeing a laptop with an image on it.
  • She reported a memory of seeing a beautiful meadow. This is such a common theme in NDEs that we see it in the previous case, subject J who also reported a meadow. My father who told me about his NDE said he remembers a beautiful meadow with a figure of white at the end of it. These meadows are not OBEs as we understand them, they are a part of the narrative arc that NDEs or REDs follow…the heavenly realm. These usually occur after any OBE reports from the ER room.
  • The wording of her report suggests she is a bit muddled as to what happened to her and this is the only snippet she can remember, and associates it with the doctors. Of note is the fact that many of the subjects knew nothing about NDEs before the report. This is Austria, not the US where the media is very active on this topic.

How on earth did they take this information and come up with the ludicrous statement:

“it vindicated the generally accepted view that consciousness depends solely upon brain function”

CONFLATION – the tool of those who have a weak or non-existent argument. It is something I talk a great deal about in my book on the origin of life DNA:The Elephant in the Lab, (available in all countries) a subject I have academic expertise in. Scientists often conflate different facts to make an argument that isn’t there. I like the Wikipedia description of conflation:

Conflation is the merging of two or more sets of information, texts, ideas or opinions into one, often in error.[1] Conflation is defined as fusing or blending, but is often misunderstood as ‘being equal to’ – treating two similar but disparate concepts as the same.

https://en.wikipedia.org/wiki/Conflation

So what is the conflation here?

The lady reported seeing a meadow during CA[Fact1] + the laptop did not show a picture of a meadow [Fact 2] = consciousness depends solely upon brain function

It is a conflation because the lady’s report of an image and the fact the laptop didn’t show that image are completely and totally unrelated and not even associated. She didn’t see the laptop…so what? She didn’t report an OBE. The laptop image is irrelevant.

This is monstrous, and their outrageous bias destroys the credibility of what was otherwise a very well designed and conducted study, that if interpreted objectively supports data from other studies. Of course, that won’t stop some materialists leaping on this and saying it is proof that the brain produces NDEs because these neurologists have said it does.

A part of me wonders about the backstory here. Imagine that the team hear that a lady has reported an image (an incorrect assumption from my understanding and explanation from above – she reported a memory), and that this gossip spreads to the wider hospital taking on the form of a report from an OBE. In the time between the interview and revealing of images actually displayed, there may have been a cohort of NDE believers that started to believe, and maybe even claim that they had proven an OBE. The materialists may have momentarily been on the back foot, but when the great reveal comes…BOOM!…no image of flowers. Revenge is a dish best served cold and this paper may be revenge. Any researchers involved in the study who were believers retreated and allowed the materialist neurologists to write it up. Big mistake, as I have shown above. They have embarrassed themselves and their colleagues. Anyway, that is just my author’s imagination running wild…but you can see it happening given the size of egos in academia.

Back to square one. This study proves nothing about OBEs or NDEs, except they are relatively infrequent and all but impossible to scientifically measure.

If you enjoyed this post and haven’t “bought me a coffee” yet, then please feel free to show your appreciation:

https://www.buymeacoffee.com/orsonw23W

UNCOOL (updated on 29th January)

This post is a doozy, you will need to get your noodle into high gear as we will be delving into 4 publications on or related to the subject of NDEs during HCA (hypothermic circulatory arrest). Before we start, can I ask you a small favour. This blog costs money to create, and time to write. If you have been coming here for a while and enjoy reading what I write, then I would be grateful if you “bought me a coffee” (if you are rich, you can buy more than 1!). This site is trustworthy and used by media creators around the world to get appreciation for creators like me. You will need a credit card, provide the number, expiry, CVV number AND your zip code – the details are not passed on to me or held on the Buymeacoffee site (BTW it’s easy to forget the ZIP code which tripped me up when I tried it out for the first time today, you need to scroll across the details box). If I get lots of support it may motivate me to write more!

My Buy Me a Coffee page (yes, my real name is Orson…Ben Williams is a character in one of my novels)

Now to the blog. So this is not a great news blog for those longing for that illusive scientifically verified OBE, and may be bad news for Parnia’s HCA study, but there is a caveat with that.

So to the first paper (big shout out to Constiproute for alerting me to this one – how did I miss it!!):

Does Hypothermic Circulatory Arrest for Aortic Surgery Trigger Near-Death Experience? Incidence of Near-Death Experiences after Aortic Surgeries Performed under Hypothermic Circulatory Arrest

Ref: Manduit et al; Aorta (Stamford). 2021 Apr; 9(2):76-82. doi: 10.1055/s-0041-1725091

Brief summary of design, methods and results:

Design: It was a prospective study looking at consecutive patients who underwent thoracic aortic surgery between July 2018 and September 2019. Procedures without HCA were included to constitute a control group. The primary outcome was the incidence of NDE assessed with the Greyson NDE scale during the immediate postoperative course, via a standardized interview.

Results: None of the patients reported any recollection from their period of unconsciousness. There was no NDE experiencer in the study cohort.

This makes AWARE II look like a resounding success! The authors sound slightly bitter in their summary of the results, as far is it possible to sound bitter in a clinical study publication.

Firstly let’s get into the weeds. This is a well designed prospective controlled study which makes it a very credible study.

The procedure basically requires cooling the body to 21-28oC by using a bypass technique that cools the blood, and once this temperature is achieved circulation is halted. At this temp many of the metabolic processes that occur within cells are slowed to the extent that damage will not occur, particular to brain tissue. However, after 30 minutes things may get more dangerous and another technique is initiated that restores flow of fluid to the brain. Here are the numbers recruited.:

Overall ( n  = 101)HCA group ( n  = 67)Control group ( n  = 34)

All patients survived, and while it is not stated (something the editors or reviewers should have picked up) I assume that all were interviewed. Given data from previous NDE studies looking at CA survivors, you would expect about 6 reports of NDEs from the HCA group given that they were in circulatory arrest. However there were none.

In the lengthy discussion section a number of factors were listed as potential confounders which might have caused this lack of NDEs. Here they are verbatim:

  • The hypnotic agents and analgesics used during general anesthesia may induce retrograde amnesia, or merely prevent NDE, although some NDE during anesthesia have previously been described. 
  • The potential influence of modified neurotransmitter release and systemic inflammatory response induced by the CPB, along with the varying degrees of ischemia/reperfusion during aortic surgery, should also be taken into consideration. 
  • The duration of unconsciousness in our study (14.4 hours on average), inherent to the prolonged general anesthesia, might prevent the patient from remembering NDE events. Furthermore, the time between awakening from anesthesia and the patient’s interviews might have been too long.
  • The number of patients included in our study might also be too limited to evidence NDE, although the incidence rates reported among cardiac arrest survivors suggest that such cohort size should be adequate.
  • The level of hypothermia and the optional use of adjunctive cerebral perfusion during circulatory arrest might also play a crucial part. 

The first 4 are self explanatory. The issue of being under sedation prior to CA is something that I think is potentially relevant. Does the consiousness need to be consious when CA occurs for an NDE to occur? Not convinced personally since I can recall of NDEs that have been reported when patients were under anesthesia, had a CA during a procedure and consiousness started at that point with the NDE ensuing. Moreover we have the cases from the HCA study in Montreal (the original COOL study) led by Mario Beauregard. I will return to that in a moment.

It is the fifth point that interests me and two papers that are cited in the section of the discussion that delves into this.

Electroencephalography During Hemiarch Replacement With Moderate Hypothermic Circulatory Arrest by Keenan et al in 2016

and

Deep hypothermic circulatory arrest: I. Effects of cooling on electroencephalogram and evoked potentials by Stecker et al in 2001

To summarize the key points, with the application of cerebral perfusion (used in both studies), the EEG does not in general become silent until the body has reached a temperature of 16oC. Below about 24oC it goes into burst suppression, during which consiousness is not possible. This is the status usually encountered during anesthesia.

In summary there are 3 states and outcomes to consider:

  1. Temp >16oC no circulation (artificial or natural) = isoelectric EEG or clinical brain death in under a minute.
  2. Temp >16oC with some kind of circulation, either natural or artificial = EEG activity of some kind.
  3. Temp <16oC with or without circulation = no EEG activity and clinical brain death.

Now I will discuss the Beauregard study from Montreal. The details were published in a journal as a letter which does not require peer review. It was more hypothesis generating than anything, and was supposed to be the launch pad for a larger scale prospective study, but it never happened. Anyway, here is a link to the letter:

Conscious mental activity during a deep hypothermic cardiocirculatory arrest? Beauregard et al 2011

In summary, it was a retrospective study looking at cases between 2005-2010 in which 33 patients underwent DHCA ( deep hypothermnic circulatory arrest), and were interviewed afterwards. 3 reported consious recollections, and one had an OBE, the details of which were later confirmed to be accurate. Given it was retrospective and in such a small cohort, the evidence is a little sketchy (unless you add it to the mountain of other evidence), however this is what has inspired further study. So there is one huge question to ask, why did Beauregard’s study have NDEs and Manduit’s not?

It is noteworthy that when looking at Keenan’s paper, the methods for HCA appeared to change around 2010-2013, with cooling often going to 21-28oC, whereas during DHCA conducted prior to 2010, it appears the body may have been cooled to 16oC or lower.

This may be the key difference between Beauregard’s (recruited 2005-2010) study and Manduit’s (recruited 2018-2019). However, given that in Manduit’s study only 31% of patients had ancilliary cerebral perfusion, therefore 69% would have had isolectric EEG (although they did not measure this), I am not sure this would make any difference in terms of potential for NDEs.

However, this is potentially hypothesis generating regarding the interation between consiousness and the brain in a dualist understanding of our existence, and which I will delve into during the discussion or in another post because I think this is enough for now.

Finally, this has implications for Parnia’s HCA study. Is he using DHCA cooling to 16oC, or MHCA (moderate HCA) and only going to 21-28oC. Is there cerebral perfusion? The answers could effect the outcome.

Wow, my brain is overheating – definitely not 16 or even 21-28oC…it is smoking!

Please review the papers yourselves and see if I am adding 2 and 2 and getting 762, but I think I may be right on this.

Finally, surely after that, you want to buy me a coffee

My Buy Me a Coffee page (yes, my real name is Orson…Ben Williams is a character in one of my novels)

AWARE II preprint analysis

So having had time to look through the preprint of the AWARE II paper, I will only add comments on new information that wasn’t present in the talk at AHA, and it basically boils down to two things – the reports of external awareness – in particular the visual report, and the EEG data.

On the report of visual awareness, this is from the paper:

“…one describing “hands being on him” and voices shouting. Another, “heard people talking…” and drugs given but without specifics. The same person (1/28 [3.5%]) perceived visual awareness of doctors. He felt like he was further away but could see what was going on, including hearing/seeing doctors getting organized and a doctor with a “surgical hat and blue scrubs”. He said he “could feel someone rubbing the bony bit” on his chest. During stage 3, no further information for independent corroboration was provided.”

When you look at this case, I would say this is much more likely to be CIPRIC than a genuine OBE. Not what I would like to say, but nonetheless feels true given he reports feeling procedures. It is possible he was “half-in half-out” but no evidence to support this UNLESS they also collected EEG and it was flat during the episode he describes…which brings me on to the EEG data. I refer specifically to this paragraph:

“EEG data were obtained from n=85 subjects, but due to electrical interference, electrode malfunction, motion artifact data, only 53 had interpretable EEG data. Thus, of 851 total EEG images captured, 466(55%) were interpretable (Figure 1.A). Of these 53, n=49 also had rSO 2 with mean SD rSO 2 43.49, consistent with significant ischemia (normal~70%). Those not-interviewed had a similar rSO 2 to those interviewed. Among the 28 interviewed survivors, mean rSO 2 was similar between those with and without memories. Although, absence of cortical brain activity (suppressed EEG) was a dominant finding (47% of data/images), seizure-like (epileptiform) activity also emerged (5%) (Figure 1.B). Importantly, near-normal/physiological EEG consistent with consciousness also emerged: delta, theta activity in 22% and 12% respectively (up to CPR 60 minutes), alpha 6% of data/images (up to CPR 35 minutes) and beta 1% (Figure 1.B). Near-normal EEG patterns were observed throughout CPR, however, their relative frequency declined over time, especially after 50 minutes of CPR. In parallel, there was a relative increase in suppressed (absent) EEG. Seizure-like activity occurred after 10mins of CPR but remained steady (~12-24% of all EEG recordings) throughout (Figure 1.B). Modeling the likelihood of the emergence of the EEG patterns, we identified a significant difference in the predicted probability of the emergence of the three categories of EEG (normal-near normal, seizure like activity, absence) with prolonged CPR duration (p<0.001) (Figure 1.C)2”

Firstly, the Parnia lab are to be congratulated on what is a truly innovative and ground-breaking piece of research. As they state in the discussion, this is the first time that real-time EEG data has been collected in a prospective study during CPR, and given the fact that near normal EEG patterns were observed in some patients throughout CPR, it raises the possibility that NDEs could be explained by brain activity. However, without further detail, and specifically the tables, I am going to guess that it is quite unlikely given that one of the 6 patients who had “transcendental” experiences has EEG data given that less than 10% of all subjects had interpretable EEG (I am assuming the percentages quoted in the above paragraph are for the whole EEG population, not just those who were interviewed…this should be changed by the editor before final publication with numbers as well as percentages). Now if one of the 6 did have interpretable EEG, then it could prove positive for either camp, but would favour the dualists. There are two scenarios if there was interpretable EEG data for any of the 6:

  1. The EEG data was inconsistent with conscious activity. This would be slightly positive for dualists…but only slightly without time stamping of validated external recollections…which we already know don’t exist.
  2. The EEG data was consistent with the potential for conscious activity. This would be slightly supportive or the materialists, but for the same reason as it would not be conclusive in scenario one it would not be conclusive here.

Ultimately, even when we do see the tables, I am pretty certain we will not be able to draw any definitive conclusions about the nature of consciousness, or of the cause of NDEs from AWARE II. Most, if not all of the EEG data, is for people who didn’t report an NDE.

Parnia points to his study in patients undergoing hypothermic circulatory arrest as maybe unlocking the puzzle. My next post will be about this, and why I am concerned that this may be a false hope, and if he did stop collecting data for AWARE II in March 2020, then he may come to regret it.

AWARE II PAPER

Finally, we have a publication, albeit a preprint. Link below – it is opensource, which the final version may not be.

AWARE II PREPRINT

Thanks again to Z, always first off the mark!

Having had a very quick skim read here are my initial thoughts:

  • Nothing radically different from the presentation Parnia gave at AHA in November
  • The visual “OBE” was not verified, and would be easy for skeptics to dismiss
  • The auditory OBEs don’t sound convincing either
  • It isn’t clear whether there is any correlation (or not) between EEG signals and recalled experiences…need to read this in detail
  • A nod to the potential for better data from the COOL type study they are currently doing

I may have missed something epic, but I don’t think so. Full analysis of the details to follow below on Sunday as I am busy the rest of today. First impressions though are certainly not what we had been hoping for prior to November, but maybe what we have been expecting since then.

(FULL ANALYSIS IN NEXT POST)

11k downloads and crickets – Poll

Apologies for diverging from the main subject, and I know some of you really get the hump when I do this, but rest assured, I will be creating a new on-topic post by the end of the month. (As a reminder, there are no ads on this site)

I learned something this morning that is troubling me. Last summer I created a post around a novel that I had been working on for a few years…actually it was intended to be a series. I uploaded the first 3 chapters of the latest draft, and asked people to let me know what they thought. I had a small number of positive comments, and 1 negative comment. I decided there wasn’t enough interest in it for me to invest hundreds more hours and dollars on finishing this draft and getting it edited.

Today I was going through last years stats which were the best yet, with quarter of a million views and 40k unique visitors (thank you!), then I noticed the downloads. To date there have been over 11,000 downloads of the novel sample! Now I know I asked people to comment, but either it was so embarrassingly bad, or it’s possible people are lazy, or didn’t notice my request to send comments. Anyway, to get final closure on this matter, I decided to create a poll which is much easier to respond to than sending a comment or message. Please only answer this poll if you read the sample chapters, or started reading them and thought they were so bad you stopped (here is the link if you wish to download again or for the first time: CLICK TO DOWNLOAD FIRST 3 CHAPTERS

If you answered yes to the above question, and the novel was 60,000 words (say 300 pages), what would you define as reasonably priced? (unless I am approached by an agent or publisher, I would self publish which is much more expensive per copy and the cost per copy would be at least $6 – ebook is a minimum of $3 on Amazon, with them gobbling the lion’s share)

Of Mice and Men (or rats and humans)

Thank you Jordan for letting me know that the Parnia lab has added a video of the AHA presentation to their YouTube channel. Here is the link below:

Audio with slides of Dr Parnia’s presentation of the AWARE II study at AHA November 2022

First of all, the slides were ever so slightly different from the ones that I posted a couple of weeks ago, but there was nothing fundamentally different in the message. The presentation was very balanced and factual in nature. He is a very good presenter and extremely credible. Key points:

  1. Around the 5 minute mark he discusses recruitment and details the huge issues they have with getting significant numbers to the interview stage. While this is frustrating for everyone who wishes to get enough data to be able to draw definitive conclusions, we must acknowledge that the Parnia lab are doing their very best to get results.
  2. At 10.20 he discusses the EEG data, and this is where the title of this post has come from. We have data from EEG in rats suggesting that there is some brain activity, and we have human data from previous case studies and now AWARE II suggesting “spikes” in EEG activity, including some gammar, which he specifically states is “usually associated with consious thought processes, recall of memory and so on…”. It is important to note that the amount of gammar is not presented.
  3. At 11.35 he makes a very intriguing comment in the discussion on implicit learning. He acknowledges that the sample size was too small and that we need larger studies to get better information on testing the implicit learning aspect, but he said this: “we had one case that worked“. Nothing more. Mmm.
  4. He spends a considerable amount of time on the fact that most patients when discussing their life review focus on morality and ethics rather than religion. He suggests this is curious and intimates that this is not something easily explained by medical or scientific understanding.

There is very little for the dualist in his presentation, but without exceptionally strong supporting evidence, I would not expect that at a scientific congress like this one. He gives lots of meat to the materialists, more so than we thought. The suggested implication that the EEG spikes are associated with consious processes and memory recall is provocative to us, especially without any specific evidence that links the two seperate observations (they may not even be in the same people). I believe he is giving attendees the opportunity to think what they want of this, and many will go down the rat route and mix dubious association with actual causation. It is unclear from this whether he believes this to be the case, but given his past statements, I suspect not.

As stated previously, in the absence of time stamped EEG data correlating with specific recollections, the EEG data is thought provoking, but does not inform us what is actually happening. I very much hope the paper will have more on this.

But what about the case “that worked”? No further details were provided, and I suspect he is saving that for the final publication. Is he referring to the 1 visual or 2 auditory recollections? Why did it “work”? Watch this space, but suffice to say, once again Parnia is leaving us in a state of expectant limbo!

Key points from AWARE II presentation at AHA 2022

Someone very kindly provided me with a copy of the slides from Sunday’s presentation. They sent them to me because I have a Ph.D. and I work in research therefore I will respect the sender’s request that they only be presented in an academic context and I will not post any of the actual slides on here, or supply copies. That being said much of the key bits of data can be found in the abstract that Z posted the following link to:

Link to AHA 2022 AWARE II abstract

Now to the presentation.

The background looks at the physiological factors around death and resuscitation, and has a slide on the pig study. It then looks at the different types of experience that are recalled, and also the psychological impact of these experiences. The historically low percentage of visual recollections is highlighted and he uses AWARE I as a source of evidence for this. He then moves on to the study itself.

Firstly he states 3 specific hypotheses related to Near Death Experiences:

  • Consciousness and awareness – with explicit and implicit learning – and cognitive experiences occur during cardiac arrest
  • Cognitive experiences may be related to the quality of brain resuscitation.
  • Experiences during states of unconsciousness may impact longer term psychological outcomes in survivors

It is important to note that while the first hypothesis refers to consciousness during CA, none of these hypotheses explicitly relate to dualism or refer to the possibility of the consciousness surviving death, which is after all what we initially believed the AWARE studies were about, and what in fact Parnia himself has stated repeatedly in public outside of the context of a clinical scientific audience – an important point. The second and third hypotheses relate more to his medical discipline as an ER doctor.

In subsequent slides he details the design of the study, and there is a new twist to this. Due to the lack of survivors from CA, a sad but inevitable problem that has plagued all his studies, he has decided to include retrospective data from reports of consciousness during CA that did not occur within the prospective AWARE II study. This was to provide qualitative information on experiences. As a researcher myself, I find the inclusion of retrospective data in a prospective study a little troublesome. I get why he might do this, but it makes the research potentially messy. However, thankfully that does not happen when it comes to the presentation of the prospective results.

After this the other techniques are discussed – brain oxymetry, EEG, headphones and a tablet generating audio and visual “clues”.

During the study memories that were reported were measured against a 32 point NDE scale, and any visual or auditory reports were collected and cross referenced with computer files listing the clues that were generated at the various timepoints.

Results:

As the abstract states 567 patients were “recruited”, but only 53 survived to discharge and of these only 28 were interviewed.

This is where I actually want to stop writing this post. It is incredibly disappointing to have such low numbers. In truth after more than 5 years they only obtained a sample of 28 subjects to glean information from. This is less than the number for AWARE I. I am not criticizing Parnia or his team – what they are aiming to do is very hard, and the fact that so few patients survive is the main reason why in my view, and I suspect the view of most who frequent this blog, the study “failed”. Given that from previous studies we know that only 2-3% of patients who experience clinical death and are resuscitated report NDEs with visual recollections, I have always said that you would need to have many hundreds, if not thousands, of interviews to stand a chance of getting a hit. The reasons for this are not just related to low percentages having visual recollections, but also to the chances of someone actually seeing and remembering the projected images if they were lucky enough to have a visual OBE. Anyway, I have flogged that horse to death many times here so back to the results.

In terms of patient characteristics, due to the low numbers of patients who were interviewed vs not interviewed, which mainly reflects survival vs non-survival, most differences do not reach statistical significance, except sex with a higher proportion of men being interviewed than women than the proportion reflected in the total study population, and age, with those being interviewed being younger. The first point is interesting since I think that historically women were more likely to report NDEs than men. Oxymetry data shows a trend of higher levels of oxygen in patients who survived. This has been observed before.

In terms of participating sites, the greatest proportion of patients came from the UK.

Now we get to some interesting tidbits…I’d love to post the graphics, but that would be disrespecting the kind chap who provided me with the slides.

There is a flow chart showing % of patients who had a tablet , oximetry and EEG installed, with the key data being for those who survived to interview (28):

  • 22 had tablets with files recording what was displayed
  • 24 had oximetry with 11 having meaningful files
  • Only 6 had EEG installed and if I am reading the flow chart correctly, only 2 of those interviewed had interpretable EEG files.

This last point is extremely important when it comes to drawing any conclusions about the relationship between reports of awareness and brain activity. You can’t.

How many reported awareness?

  • 11 of the 28 patients had memories or perceptions.
  • 6 reported transcendent experiences of death (he seems to have dropped RED in this manuscript and gone back to TED 🙂 )
  • 2 reported CIPRIC
  • 2 had memories post CPR
  • 3 had dream or dream-like experiences

This data partially verifies his first hypothesis.

The 6/28 is where Parnia get’s his 20% having NDEs (21% to be precise). Given the small sample size this is well within the bounds of error of previously reported numbers of 10%. Now for the core bits of data…the OBEs.

  • 2 of 28 had auditory OBEs
  • 1 of 28 had a visual OBE
  • None of 28 were able to identify the correct image including the patient who had a visual recollection – big miss for us on this blog
  • 1 subject was able to identify the correct fruit from the auditory stimuli. This is the hit that was first mentioned back in 2019. It’s hard to know what to make about this without ECG and/or EEG data correlating with the time of the audio file. It could be a bona fide hit. Either way, this possibly fully verifies his first hypothesis provided the patient was proven to be in CA.

There was no statistical difference (p=0.55) in terms of oxygen levels between patients who had memories or no memories. This possibly falsifies his second hypothesis.

In terms of EEG:

•Absence of measurable cortical brain activity (47% of images)

•Normal/near-normal delta seen in 22% of recordings up to 60 minutes

•Theta activity was seen in 12% of recording up to 60 minutes

•Alpha activity was seen in 6% of recordings, up to 35 mins

However, these are not specific to patients who were interviewed, so all the talk about recollections of consciousness possibly being related to brain activity are 100% pure speculation – UNLESS the 2 EEG files he has from the interviews specifically cross reference recollections with EEG spikes from the 6 patients who had NDEs. However we aren’t told this. It is possible that this data was verbally discussed during the presentation or more likely will be presented in the final publication. It is an important piece of data, but given that there are only 2 EEG files for the 28 who survived, even if there is some correlation with one or two of the six, the numbers are way too low to draw definitive conclusions and so I am of the view that Parnia’s reference to these recollections of Awareness being related to these is at best speculative.

The last section of the presentation refers to the retrospective study and repeats much of what has been said in the consensus statement and distinguishes REDs (yes, he uses RED here rather than TED) from other CPR related experiences such as CIPRIC.

In summary, in the absence of scientifically verified OBE or EEG data correlating specifically with strong NDEs, or an OBE, we are unable to verify or falsify the hypothesis that the consciousness is not a product of the brain. This is entirely attributable to the low numbers recruited in the study. From the PowerPoint presentation that I have, no hypothesis, either his, or ours, relating to the nature or origin of conscious awareness during CA has been validated or falsified. Given how much hope I once had for this study, I am of course very disappointed, but such is life. On a research front though, the collection of so much EEG data from patients who are in CA and having CPR is truly groundbreaking, it is just a shame that without more information we are unable to draw conclusions on the meaning of this data.

I anticipate lots of questions and a lively discussion!!

Lastly I would like to thank the lab for providing the slides for me to look at and pay my respects to the Parnia lab team, all the research sites, and the patients who took part in this study. It is no one’s fault that this study does not satisfy our desire for a “hit”, it was an epic effort and the nature of the population always made this outcome more likely than not. Also, there is another study that we still have to hear about…another day. I live in hope!!

AWARE II (interim?) results presented at AHA 2022

Thank you to Cobra for being quick off the mark and seeing this.

It appears that Sam Parnia presented the results from AWARE II at AHA yesterday in Chicago. This is a press release which has appeared on various websites, but it does not contain any specific details about observations that were made or about any correlation with spikes in brain waves and these observations.

Here is a link to one of the press releases, but they are all the same:

Press release

The key quote for me is this:

“Survivors reported having unique lucid experiences, including a perception of separation from the body, observing events without pain or distress, and a meaningful evaluation of life, including of their actions, intentions and thoughts toward others.”

Clearly, they must have at least one visual OBE…however, there is nothing in this article to suggest it has been scientifically validated, and given that they only have a pool of 567 patients who had a CA with the iPad in the room, and only 10% survived to discharge, meaning they maybe have 100 interviews at the most, I am very sceptical now that we will get the much hoped for hit.

If anyone is able to get more details please post here in the comments.

edited to add: The more I look at the press release, the more I am of the opinion that these are not the final results – we will see.

What are the chances?

This article was posted by Maria in the comments of my last post. Thank you.

Link to article on how to capture visual OBEs

The original article is over 30 years old, and this fact alone highlights just how long we have been waiting for a scientifically verified visual OBE in a research setting. When I say scientifically verified, I mean that a hypothesis is generated, an experiment devised to test that hypothesis, and a positive result recorded within that context. I have taken great pains over the years to point out that adherence to the scientific method is central to insuring the credibility of any results that emerge from a study seeking to verify OBEs or NDEs.

The hypothesis would go something like this:

The consciousness is able to persist and separate from the physical body once the heart has stopped beating and brain stopped working, and observe events externally from the body.

The experiment would then test this hypothesis by creating a method by which the ability to observe events during this state is assessed. This paper describes the type of visual stimuli and location that would be best, based on interviews of people who reported OBEs during their NDEs. Presumably Sam Parnia read this article as a reference for designing this aspect of the AWARE study. He placed cards on shelves near the ceiling in various ICU wards in different hospitals. Despite there being a total of thousands of these cards dotted around hospitals all over the world, none of the reported NDEs from AWARE 1 occurred in a room with a card. The reasons for this have been discussed multiple times before. While reports of NDEs are very common, deliberately setting out to prospectively observe patients who have a CA with an NDE and an OBE and who then survive long enough to be interviewed is extremely difficult. Reports of murders are common, but if you set up an experiment to try to witness a murder, it would be very hard. Maybe a clumsy analogy, but my point is that while a random event may occur commonly, being able to deliberately observe that event may not be straight forward.

This problem has also plagued AWARE II despite its updated methodology and slightly tighter inclusion criteria, and based on the preliminary data presented at AHA in December 2019, it seems unlikely that when the final results are published that there will be a verified visual hit. This quote from the article’s conclusion predicts our torture all the way back in 1988:

the process of accumulating sufficient data in hospital veridicality research may be protracted

No kidding!

There is another problem with the AWARE studies. The above hypothesis that I state is not specifically included in the study, and the studies are not designed with the specific intent of testing this hypothesis. Testing this kind of hypothesis may have been Parnia’s original intent when he started out, but possibly for credibility reasons, he has not been able to explicitly state this in the study designs. The studies have therefore been hampered in their ability to achieve the outcome of proving this hypothesis as a result. If there is a scientifically verified OBE it will be a byproduct of the research in that the stated aim of the visual and auditory experiments is to better understand the nature of reports of conscious awareness rather than prove the above hypothesis.

Finally, any publication that Parnia submits will need to be peer reviewed. Peer review is far from a flawless process and is subject to the personal biases of the reviewers. Given the hostility in the materialistic scientific community to research that might challenge the prevailing materialistic orthodoxy, any evidence that Parnia presents to support this hypothesis will scrutinised very closely and potentially arbitrarily dismissed by reviewers. We only need to look at the COVID lab leak vs natural emergence fiasco to know without doubt that the scientific community is capable of subverting the truth if the truth challenges their preferred narrative.

Given all of this, I am becoming quite gloomy about the prospect of the paper that presents results from AWARE II including any scientifically verified OBE. It is due in the next few months, so we should know one way or the other.

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.

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