Oct 09 2014

AWARE Results Finally Published – No Evidence of NDE

Back in May I participated in a debate for Intelligence Squared regarding “Death is not Final.” At the time I was updating myself on the published literature regarding alleged near death experiences or NDEs, and noticed that the AWARE study (AWAreness during REsuscitation) had been completed but the data not yet published. I was disappointed that I would not have these results available to me during the debate.

I had read about the study several years earlier. This is a prospective study of cardiac arrest patients to not only describe their NDEs when they occur, but to conduct a large prospective test looking for objective evidence of conscious awareness during resuscitation. The lead researcher, Sam Parnia, is a believer in NDEs, but designed a study theoretically capable of finding objective evidence.

The multi-center study involved placing an image in a location that was hidden from normal view but could be viewed by a person floating above their body during an NDE. This could be a way to objectively differentiate between the two leading hypotheses. Parnia and others believe that reports of NDEs represent actual awareness during cardiac arrest when the brain is not functioning. This, of course, would be compelling evidence for cognition separate from brain function.

I and most scientist favor the more mundane and likely explanation that memories of NDEs are formed at other times, when the brain is functioning, for example during the long recovery process. At least the memories themselves do not differential between these two hypotheses, and this explanation does not require inventing entirely new non-materialist phenomena.

So, I anxiously awaited the results of the AWARE study. I admit I was fairly confident that the results would be negative. My major concern was that the study had been criticized for not having tight protocols – for example, some have charged that the “hidden” images were visible to ER workers and this could provide a mundane conduit for knowledge of the images to get to cardiac arrest survivors. But I hoped this did not occur or affect the results.

Here, finally, is the published study.

But wait a minute – there is no mention in the abstract of the hidden images. How can that be? I understood this to be the main outcome of the study, the one thing that would set it apart from the merely descriptive studies of the past. What happened?

There are two mentions of the hidden images in the discussion only.

While the low incidence (2%) of explicit recall of VA impaired our ability to use images to objectively examine the validity of specific claims associated with VA, nonetheless our verified case of VA suggests conscious awareness may occur beyond the first 20–30 s after CA (when some residual brain electrical activity may occur) while providing a quantifiable time period of awareness after the brain ordinarily reaches an isolectric state.


While pre-placement of visual targets in resuscitation areas aimed at testing VA was feasible from a practical viewpoint (there were no reported adverse incidents), the observation that 78% of CA events took place in areas without shelves illustrates the challenge in objectively testing the claims of VA in CA using our proposed methodology.

Well that’s disappointing. However, apparently there were no cases of cardiac arrest patients who were able to see, remember, and report the hidden images. Collecting data was more difficult than they hoped, but the results they did get were negative.

Why, then, am I seeing headlines like this one from the Telegraph: First hint of ‘life after death’ in biggest ever scientific study. And what was that reference above to “our verified case?”

Failing to obtain any actual evidence that NDEs represent non-corporeal cognition, Parnia apparently decided to fall back on the old, let’s just report what people say and present that as if it were actual objective evidence. Let’s take a look again at the results:

Among 2060 CA events, 140 survivors completed stage 1 interviews, while 101 of 140 patients completed stage 2 interviews. 46% had memories with 7 major cognitive themes: fear; animals/plants; bright light; violence/persecution; deja-vu; family; recalling events post-CA and 9% had NDEs, while 2% described awareness with explicit recall of ‘seeing’ and ‘hearing’ actual events related to their resuscitation. One had a verifiable period of conscious awareness during which time cerebral function was not expected.

The one case that is being touted as evidence is a patient who apparently described details of the cardiac resuscitation. Parnia is referring to this as “verifiable conscious awareness.” Not so fast.

Let’s put this into some perspective. Out of the 140 cases that were interviewed, only 1 case reported memories of events during the cardiac arrest that Parnia deemed “verified.” All 140 cases were given one interview, 101 were given a stage 2 interview, and the one patient was given a stage 3 interview by Parnia.

The discussion gives the reason the multiple interviews is significant:

Furthermore owing to the acuity and severity of the critical illness associated with CA, the time to interview for patients was invariably not exactly the same for every patient, which may have introduced biases (such as recall bias and confabulation) in the recollections.

Subjects were often interviewed after they were discharged from the hospital, even for the first interview (although some were interviewed while still in the hospital). Imagine slowly waking from a delirium, over hours or even days. Even when you appear awake and are able to answer questions and interact, your brain has still not quite recovered from trauma of cardiac arrest, and you may also still be ill, even receiving sedating medications.

Your brain is struggling to reconstruct memories of what happened through the fog of delirium, and will do what it can to construct a narrative of what occurred. We know from countless psychological experiments that our brains will happily fill in the gaps any way in can (this is called confabulation) – it will fuse memories, make up memories, incorporate details from outside sources, and morph over time to fit an evolving narrative of what happened.

So yeah – biased and confabulated recollections recalled long after the event, influenced by multiple interviews, is certainly a weakness of the study.

What is a little surprising to me is that Parnia could only come up with one case with a memory that can be presented as matching events during cardiac arrest. This does not make that one case “verified”, it makes it highly selected and filtered from a larger set of data.

As an analogy, this is similar to an alleged psychic working a room with 40 people, and making a cold reading guess that is a good match to one of the people. It is fallacious (known as the lottery fallacy) to ask what the odds are that the alleged psychic would have had a hit to that one person. Rather, we need to consider the odds of hitting any of the 40 people, and to expand it further to any possible hit, not just the one made.

We need to consider what the odds are that one of the 140 people would have a memory (almost certainly contaminated, as no procedure was in place to prevent contamination) that matched events during cardiac arrest in some arbitrary details. This certainly sound consistent with random background noise in the data, and is therefore not evidence of anything.


The much anticipated AWARE study, designed to be the first large rigorous study of NDEs with objective outcomes that could potentially differentiate between the two major hypotheses, is essentially a bust. The study, for the main outcome measure for which it was designed, did not return as much data as was hoped, but the data it did return was entirely negative. This is a negative study.

Parnia, in my opinion, is desperately trying to rescue the study by falling back on simply reporting subjective accounts of what people remember long after the event. This type of information is nothing new, and cannot objectively resolve the debate. The results are also completely unimpressive, perfectly consistent with what we would expect given what is already well documented about human memory.

The only relevant part of the study is Parnia’s admission that the results may be due entirely to confabulation. Spinning of this study in the popular press as evidence of life after death is not justified.

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