Robert Blum Website

Robert L. Blum, MD, PhD

Near Death Experiences:

In the Tucson Desert

With Dr. Pim Van Lommel

May 4, 2010

(Also see my Oct 24, 2012 addendum at the very end on
Neurosurgeon Eben Alexander's report that "Heaven is Real.")

Are Near Death Experiences (NDEs) real or not?

My answer is that the reports are real. (Some people earnestly believe

they had a profound experience traveling outside their bodies,

meeting deceased relatives, reviewing their lives, and are deeply transformed thereby.)

The real question is how to interpret their NDEs. Did they ACTUALLY travel

outside their bodies and meet the souls of dead relatives while their

EEGs showed they were brain-dead? My answer to that is "No. No way!"

Paradiso-Canto

Gustave Dore's depiction of the highest heaven as described by Dante Alighieri

in the Paradiso (from Wikimedia Commons).

Forever the hard-bitten skeptic, your roving reporter was recently

shoved by fate (which famously works “synchronistically” and in strange ways)

into a delightful three hour hike and dinner with one of the world's

most famous researchers of NDEs, Dutch cardiologist Dr. Pim Van Lommel,

whose book Consciousness Beyond Life will be released in the USA in June, 2010.

I was attending the wonderfully eclectic TSC Conference

(Toward a Science of Consciousness) in Tucson, sponsored by the University of Arizona.

Since my main interest is in the neurobiology of consciousness, that was the main draw.

Among the banner invitees were Professors Antonio Damasio (emotional brain) ,

Marcus Raichle (default networks - wandering thoughts), Christof Koch

(NCC and Jennifer Aniston cells), Karl Deisseroth (optogenetic, laser-controlled mice)

- all A-list neuroscientists. Next, were the philosophers of mind including

famous names like David Chalmers (the easy vs the hard problem of consciousness) ,

Harvard’s Eugene Taylor, consciousness theorist Bernard Baars (global workspace), and

the computer scientists: Dharmendra Moda (IBM's connectome project)

and Ben Goetzel( AI guru and CEO of Novamente), who, like me, are trying

to determine if you can do it in silicon.

That's perhaps half the ideation of the TSC Conference, but then it gets,

shall we say, increasingly speculative ("further out"). Enter the researchers of

transformative experiences (Cassie Vieten) and enlightenment (Jeffrey Martin);

add in those seeking to establish a basis for consciousness

in quantum mechanics (Stuart Hameroff (famously joined by Roger Penrose);

further mix in those studying meditation and psychopharmacology,

fold in ZA Choeje Rinpoche (the “reincarnation of the 6^th Dali Lama”),

and top it all off with sci-fi writer Rob Sawyer and some sixties-style

art and song and you’ve got an informative and entertaining week

in the Arizona sun (Burning Man for eggheads or Society for Neuroscience on LSD).

Sabino Creek

Sabino Creek in Tucson, Arizona

Now, back to Dr. Pim Van Lommel and NDEs.

After touring the verdant, riparian Sabino Canyon in the Tucson desert,

I have an hour to kill before dinner. I want to hike more, but there is no one around.

Suddenly, there is Julia Mossbridge, a psych post-doc from Northwestern -

a willing hiking partner. As we hunt for directions for our desert stroll,

she spies Dr. Van Lommel and asks him to join us.

As we head out amidst the sand and cactus, Pim (Van Lommel) tells me

that he was the organizer and lead author on a 2001 Lancet article on NDEs,

the largest, most detailed study to date. This study made headlines throughout the world,

and Pim has lectured about it worldwide. Furthermore, the Dutch edition of his book
Consciousness After Life already sold 100,000 copies in his native Holland

alone and thousands more in Germany.

Pim on a magazine Cover

"Proves the existence of the soul ! ?" That is Ode selling magazines.
As a researcher, Dr. Van Lommel is far more circumspect.

Pim’s study helped inspire another large multi-institution study of NDE’s

now going on in the USA and the UK. That is the Human Consciousness Project

whose lead researcher, Dr. Sam Parnia, was recently interviewed by MSNBC News on NDEs.

(This entertaining video was on my short-list to show at my recent two hour lecture on

mechanisms of consciousness.)

Over the next three hours we discussed many of the details of Pim's study

and of the NDE phenomenon itself. Here I paraphrase and summarize our conversation.

RLB: Tell me about the study!

PVL: I organized this study, and then conducted it over the course of ten years.

I am a cardiologist, now retired. My father was a neurologist. (Pim is age 67

and is in great shape. He, like me, loves hiking and the outdoors.)

The study included 344 patients who had experienced cardiac arrest.

Of those, 62 patients (18%) had an NDE (near death experience).

RLB: Of the 62 patients who experienced an NDE, were the experiences all the same?

PVL: There were many elements that they had in common, for example,
moving toward a bright light and floating out of one's body,
but most NDE patients did not have all the elements of a deep NDE.

(I’ve reproduced Table 2 from his 2001 Lancet paper to show the elements that characterize

an NDE and how often they were experienced by patients in the NDE group.

These elements comprise the Weighted Core Experience Index WCEI developed in 1980

by Ken Ring, a well known NDE researcher. The table also shows

the approximate sequence of events in a deep (full) NDE.)

Elements of an NDE (total number of NDE patients =62)

1 Awareness of being dead 31 (50%)

2 Positive Emotions 35 (56%)

3 Out of body experience 15 (24%)

4 Moving through a tunnel 19 (31%)

5 Communication with light 14 (23%)

6 Observation of colours 14 (23%)

7 Observation of a celestial landscape 18 (29%)

8 Meeting with deceased persons 20 (32%)

9 Life review 8 (13%)

10 Presence of border 5 (8%).

Ascent of the Blessed

Ascent of the Blessed by Hieronymous Bosch (from Wikimedia Commons)

RLB: Before we go further, I must admit that I'm a huge skeptic of supernatural

and paranormal claims. I believe your patients reported these experiences,

but attributing objective reality to these claims is hard to swallow.

PVL: When you say you're a skeptic, do you mean you're completely

closed off to this possibility?

RLB: No, as a scientist, I'm always open to new hypotheses, but,

if you're attributing objective reality to the experiences of these patients,

then you’re making several extraordinary claims. One of my favorite sayings,

popularized by Carl Sagan, is this:

"Extraordinary Claims Require Extraordinary Proof."

RLB: I've got a number of hard questions and issues that need to be addressed.

(Here, as always, the trick is getting to the heart of the matter while remaining polite.)

PLV: Go right ahead. I've been asked all these questions by many physicians

throughout the world.

RLB (continuing): What were the diagnoses in these patients?

PVL: Almost all the patients had myocardial infarctions.

(An MI is doctorspeak for a heart attack, death of heart muscle caused by

sudden blockage of a coronary artery.

RLB: And what was the state of their cerebral perfusion (blood flow to the brain)?

PVL: Stopped completely. These patients were in ventricular fibrillation (VF).

There was no cardiac output. Without any blood flow, the brain

stops functioning within seconds.

RLB: (Here we discussed details of their cardiac arrests and resuscitations.

Pim assures me that cardiac rhythms were continuously monitored and recorded.

Without going into details, one piece of the puzzle is how long the NDE patients'

brains were without blood flow.

(No physicians - not even most cardiologists - have more experience

in dealing with acute cardiac arrests than emergency physicians. All of us

career ER doctors have treated hundreds of these cases. As front-line physicians,

it is the ER docs who are there 24 by 7 by 365 where the action is. I also taught

Advanced Cardiac Life Support (ACLS) for over a decade – this is my home turf.)

In my experience, even though VF may predominate in a given arrest,

it usually doesn't persist for more than a minute or so, although it can.

These patients are being intensively treated. They are being shocked

every 10 -15 seconds, and various drugs are being administered

(epinephrine, lidocaine, procainamide, amiodarone, et al). In a typical patient,

VF is intermittently present interspersed with ventricular tachycardia (VT) and other

partially perfusing tachycardias. MI patients also nearly always get large doses

of morphine and other opiates and doses of sedatives.

Reviewing Table 3 in the Lancet paper, I see that the average duration

of the cardiac arrest was 4 minutes. My view is that it is highly likely that

there was intermittent cerebral (brain) perfusion during that time.

I hammer him on this point, but he insists that the patients were

without blood flow during their arrests. This crucial point cannot be resolved

from the data presented in the Lancet paper.

Further examining Table 3: I see that only 10% of the patients

required intubation (putting a plastic tube into their tracheas (windpipes))

to assist their breathing. Intubation is a very high priority in a

"code blue" patient. It can be quite difficult but is extremely helpful.

The whole team breathes a sigh of relief after the ER doc has passed

the tube into the right place. That only 10% of the patients required intubation

reinforces my impression that these were brief arrests in which cerebral perfusion

was adequate to support some mentation/ cognition (albeit altered).)

RLB: How do you know there was no cerebral perfusion?

PVL: Besides the fact that the patients were in VF, their EEGs were flat.

RLB: (I ask him many questions about the EEGs (electroencephalograms).

Typically, an EEG is an elective study that a neurologist performs when

a patient is suspected of having seizures. A dozen or more electrodes are placed

on the scalp to monitor the brain's electrical activity. Getting the electrodes

to stick to the scalp is difficult without shaving areas of the scalp.

I have never seen an EEG done in a cardiac arrest. More typically

they will be done in the ensuing weeks in a comatose patient to ascertain

that the patient is "brain dead" and can be disconnected from life support.

PVL's answers to my questions about EEG monitoring were vague,

and there is no relevant data in the Lancet paper. I suspect that EEG monitoring

was only done on occasional patients, as above.

Even if an EEG is flat-line that does not mean there is no cerebral activity.

The EEG is only monitoring "local field potentials" in the cortex - the outer

few millimeters of brain tissue. There can still be normal activity in subcortical areas.

RLB: So, basically you're saying that these patients had no cardiac output,

no cerebral perfusion, and a flat-line EEG but were still capable of experiencing

NDEs with all their elaborate visual images (viewing their own resuscitation

from above, seeing deceased relatives, reviewing their lives) ?

PVL: Yes! They are having those experiences independent of and

despite the fact that their brains have ceased to function.

RLB: (I repeat my intense skepticism.) That is quite an extraordinary claim

and (if true) requires a revision of our thinking about neuroscience and consciousness.

PVL: Yes!

Pim Van Lommel, David Chalmers, and Bob

Pim with philosopher David Chalmers and I - after dinner and a few glasses of wine.

RLB: Are you religious and were many of the patients religious?

PVL: I am not religious but many of the patients were. However, the number

of religious patients in the NDE and control groups were not significantly different.

RLB: My view is that your patients are genuinely reporting their experiences but

those experiences are illusory (hallucinations or delusions). Consider the work

of Henrik Ehrsson (a Swedish neuroscientist, who presented his work at our conference,

and who joined Pim and I for dinner.) Prof. Ehrsson and others have shown that

they can synthetically induce some elements of an NDE-like out of body

experience (OOBE) by artificially stimulating some parts of the cortex.

PVL: Yes, Henrik has shown that but you must distinguish those illusory

or delusional experiences from the veridical experiences in my NDE patients.

Consider these two examples. First, is a man who had a cardiac arrest and was in a

deep coma during the resuscitation. Prior to his being intubated, a nurse removed

his dentures and put them in a cup in the bottom drawer of the crash cart.

A week later when that nurse reintroduced herself to him in the ICU, the man said,

"I remember you. You're the nurse who took out my dentures and put them

in the drawer of that cart." (This story is also told in the Lancet paper.)

Second, Pim tells me the story of a woman who had an NDE during which she

encountered a stranger who told her facts that she had never heard.

When she later recovered, her family verified the facts and identified the stranger,

whom she had, indeed, never met.

(The NDE literature is replete with stories similar to these in which

patients hover over their bodies in the resuscitation room and observe details of

procedures done on them and instruments used, all while being comatose.

These stories are part of the essential evidence which persuades adherents

like Dr. Van Lommel that souls and consciousness have an existence

independent of normal brain functioning.)

RLB: These are extraordinary claims you're making that require fundamental revisions

to neuroscience, to physics, and to our view of the Universe.

PVL: Yes. Fundamental revisions are required.

RLB: All I can do is repeat my assertion that all conventional explanations

must be ruled out before invoking these extraordinary claims.

(I mention a well-known article that British psychologist Sue Blackmore

wrote called Why I Have Given Up (on parapsychology). Needless to say,

Pim and Sue do not see "eye to eye" on these issues.)

Even though I still believe that the patients' brains were producing these

illusory perceptions, the fact remains that the experiences themselves

and their aftermath are quite interesting and deserving of study.

PVL: Yes. We interviewed the NDE patients (and a control group) initially in the hospital,

two years later, and eight years later. Almost all the NDE patients had

profound transformations in their personalities. Relative to controls, the NDE patients

underwent several positive changes: a heightened appreciation of ordinary things,

an increase in empathy, a decreased fear of death, increased involvement with their families,

and an increased interest in others, and in the meaning of life.

Ascent-to-Heaven

Triumphal Ascent to Heaven by Johann Michael Rottmayr (from Wikimedia Commons)

(This is shown in Table 4 from the Lancet study, reproduced below.)

Life-change inventory questionnaire

(p values show large differences between NDE patients and controls)

Social attitude

Showing own feelings 0·034

Acceptance of others 0·012

More loving, empathic 0·002

Understanding others 0·003

Involvement in family 0·008

Religious attitude

Understand purpose of life 0·020

Sense inner meaning of life 0·028

Interest in spirituality 0·035

Attitude to death

Fear of death 0·009

Belief in life after death 0·007

Others

Interest in meaning of life 0·020

Understanding oneself 0·019

Appreciation of ordinary things 0.0001

RLB: I am aware of Sam Parnia's on-going multi-institution study of NDE

(The Human Consciousness Project). Your study must have inspired him to undertake his study.

PVL: Perhaps. I've chatted with Sam.

RLB: It will be informative to see if his results agree with yours from the Lancet study.

(One of the interesting features of that study is that high shelves near the ceilings

were constructed in the resuscitation rooms. Images are placed on those shelves that might

be viewable, if the patient, while having an OOBE, is able to see them and accurately report what he sees.)

(Understanding how the brain produces consciousness is one of the great mysteries of science.

Until it is solved, alternative theories of consciousness including souls floating in an after-life

will continue to be promulgated even by prominent researchers. Meanwhile, my faith in
neuroscience remains unshaken. )

ADDENDUM October 24, 2012: This month there has been a tsunami of publicity about
an experience that neurosurgeon Eben Alexander had while in a week-long coma
hospitalized with meningitis.

Here he tells the whole story. As with other NDE experiencers, I have no doubt that
he is giving a true account of what he experienced and believes. However,
my interpretation of his experiences is precisely in accord with neuroscientist/intellectual
Sam Harris. If "Heaven is Real" - as stated by a recent cover of Newsweek -
then Eben Alexander's experience provides no evidence of that.

(But read the extended quote in Sam Harris's article from the late
Terence McKenna describing a protypical DMT trance. It will knock
your socks off. Now we understand William Blake, Walt Whitman and Philip K Dick.
The magic is happening in that 1½ quart organ between your ears.)