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Health & science

Off the deep end

Dr. Heimlich’s dangerous maneuvers

Dr. Heimlich demonstrating his technique to high school students in California.
For 30 years, Dr. Heimlich has said this is the way to resuscitate drowning victims.
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Published 12/8/2004

Derrick Kelly lay unconscious on the deck of Eastern Michigan University’s Jones Pool, bloody foam oozing from his mouth and nose.

At that moment on the night of Jan. 31, 2003, decades’ worth of effort on the part of Dr. Henry J. Heimlich came into play when the maneuver bearing his name was performed in a desperate attempt to get the 17-year-old Detroit high school student breathing.

As part of an investigation into the incident, one of the lifeguards who tried to revive Kelly provided this written account of her efforts:

“I proceeded to give the victim rescue breaths, the breaths did not go in. The reason being was because the male’s jaw was locked shut and his tongue was swollen and stuck to the roof of his mouth. When I unlocked his jaw and moved his tongue I gave another rescue breath. As soon as I backed away to check his pulse, bloody foam came pouring from his nose and mouth. I then proceeded to do abdominal thrusts to remove the bloody foam, and then rescue breathing after the thrusts.”

She continued the routine for about three minutes. The effort failed. Kelly never drew another breath. And in his dying, the boy became entwined in a controversy that has been roiling for nearly 30 years.

Neither Kelly’s parents, who have filed a lawsuit against the university and others, nor their lawyer would comment for this story.

One person who is willing to talk about the case is Ken Ascher, a Washtenaw County EMT who obtained details of the drowning through a Freedom of Information Act request filed with the university. Ascher, who began monitoring deaths in Michigan’s public pools several years ago, identified more than a dozen serious “errors” he alleges occurred in connection to Kelly’s death. Among those, he contends, was the use of the Heimlich maneuver, which he describes as a “waste of precious time” in a crisis where every second is critical.

His opinion regarding the use of the Heimlich maneuver to treat near-drowning victims is shared by the vast majority of the mainstream medical community. From organizations such as the American Heart Association and Red Cross to the prestigious Institute of Medicine to the nation’s leading experts on drowning, the body of opinion reached at this point is virtually unanimous: Unless the victim is choking on something, there is no scientific evidence justifying the use of the Heimlich maneuver in such cases. In fact, it has the potential to add even more complications to an already perilous situation.

The problem is that the media, which love a great man-against-the-system story, continue to give credence to Heimlich and his views on this, the experts say.

“A good story trumps good science,” is the way Mary Fran Hazinski, a pediatric critical-care nurse and the American Heart Association’s senior editor for emergency cardiovascular care programs, describes the situation.

Certainly Heimlich is prime fodder for such sensationalistic fare. After all, he initially had to wage a fierce battle with the established medical community in an attempt to have his maneuver recognized as the accepted way to treat choking victims. He insists that he’s again in the right on this issue. The maverick Cincinnati doctor, now 84, continues to wade against the prevailing scientific tide as he uses the immense good will engendered by his name to continue promoting the claim that his maneuver should be the first procedure initiated to resuscitate near-drowning victims. In public appearances and on the Web site of his nonprofit Heimlich Institute, he relentlessly maintains that mainstream medicine stubbornly resists embracing a procedure that could save thousands of lives.

The story of his efforts to gain widespread acceptance of his view over the past 30 years is a twisted tale that’s growing ever more bizarre, thanks to an Internet site (heimlichinstitute.com) that’s every bit as relentless as the famed doctor, using voluminous research to raise serious questions about the credibility of a man who has one of the most revered names in medicine. The person who created the site remains cloaked in anonymity, posting reams of documents under the pseudonym Holly Martins.

Claiming that hearing difficulties make phone conversations too difficult, Heimlich, through a spokesman, declined to be interviewed for this article. But his spokesman insists the doctor is the victim of an obsessive menace intent on destroying the physician’s good name.

“Holly Martins is a sniper operating from behind anonymity, throwing everything against the wall hoping to smear Dr. Heimlich,” says Heimlich spokesman Bob Kraft. “There’s a lot of rage and hate built up here.”

There’s also an astounding amount of material gleaned mostly from the public record — scientific journals, newspaper articles, correspondence obtained from university archives, court cases, Web sites and much more. Among the most startling allegations is the suggestion that fraudulent cases may have been used in an attempt to convince the medical community to abandon CPR in favor of the doctor’s eponymous maneuver.

People are beginning to take notice of Martins’ work. In April, the medical director of the United States Lifesaving Association wrote Heimlich asking him to provide evidence corroborating two key cases he and longtime collaborator Dr. Ed Patrick cited as proof of the maneuver’s effectiveness in treating near-drowning victims. Those cases, along with a few others, were repeatedly used in an attempt to get the established medical community to accept the contention that Heimlich’s procedure could do more than save people choking on food.

It is, from start to finish, a bizarre story that only promises to get even more interesting before it plays out.

In the beginning

Soon after the procedure bearing his name was first publicized in 1974, Henry Heimlich, then still a thoracic surgeon at Jewish Hospital in Cincinnati, began suggesting that his maneuver created to save choking victims could help drowning victims too. At the time, the medical organizations that decide such things sanctioned what was commonly referred to as a “backslap” as the approved way of dislodging objects causing a person to choke. Heimlich’s discovery was that a quick thrust to the stomach just below the diaphragm would generate a burst of air that would blow the object out, like a cork popping from a champagne bottle.

It would take a full decade of tireless crusading for Heimlich to win complete approval of the procedure.

Trying to convince the world that his maneuver should be used on drowning victims has been even more daunting a task.

The effort began in 1975, with an article by Heimlich in the prestigious Journal of the American Medical Association. Heimlich cited five reports of people “using the maneuver on drowning victims, an application that we did not anticipate. In each instance, established lifesaving techniques had been attempted first by competent first-aid personnel and proved unsuccessful. The victims, one adult and four children aged 4 to 14, recovered after the maneuver was applied. Each rescuer stated that water ‘gushed’ from the victim’s mouth.”

He conceded that the “five reports of ejection of water from the throats and lungs of drowning victims are too few for a definitive conclusion concerning the value of the maneuver in this situation. It seems logical, however, that mouth-to-mouth resuscitation or oxygen administration may not be successful when water is present in the throat or lungs. Applying the maneuver initially to expel water from the airway, then administering oxygen, would seem the most effective life-saving technique.”

By 1981, Heimlich was convinced.

“The Heimlich maneuver is the safest, most effective method [for evacuating water from the lungs] and should be the first step in resuscitation,” he wrote in an article for Emergency Medical Services magazine. Oddly, after more than five years of increasing public awareness regarding his maneuver, the doctor cited only one additional case to bolster his claim. And four years later, Heimlich still had only the same handful of cases to present when provided the opportunity to convince the mainstream medical establishment that his method should replace mouth-to-mouth resuscitation as the primary means of reviving drowning victims.

It was 1985, and Heimlich had already won a major victory when U.S. Surgeon General C. Everett Koop held a press conference to announce that the Heimlich maneuver was the approved method for dislodging solid objects from the windpipes of choking victims. It was a sweet victory. The American Red Cross and Heart Association had been reluctant to give up on the previously recommended “back- slap” method; it was only through Heimlich’s relentless efforts that the change was made.

He was now ready to do the same with drowning.

Every six years, the American Heart Association convenes a national conference to review cardiopulmonary resuscitation and emergency cardiac care procedures. Heimlich was asked to participate on the panel evaluating the protocols for near-drowning victims.

From the outset, he insisted that his maneuver replace CPR as the initial response. His reasoning was simple and straightforward: You can’t get air into the lungs until you get the water out, and his maneuver provided the best way to do that.

But that reasoning flew in the face of the scientific evidence.

Among Heimlich’s fellow panel members was Dr. Jerome Modell, one of the country’s most respected drowning experts. Beginning in the late 1960s, studies conducted by Modell found that relatively small amounts of water ended up in the lungs of most drowning victims. The reason is that, during the initial stages, a person’s vocal chords constrict, closing off the airway to the lungs. The passage can stay closed for as long as two minutes. At that point, a person will pass out and the passageway will reopen. Some water may seep into the lungs, but because the person is no longer breathing, it’s not being inhaled in significant amounts. Also, it is not necessary to clear the airway of liquid — especially if it is fresh water — because the lungs, like sponges, would absorb it when resuscitation breaths were applied.

However, in the early stages of a drowning, with the airway to the lungs closed off, the victim is likely to swallow significant amounts of water, which ends up in the stomach.

Heimlich had the chutzpah to assert that Modell was misinterpreting the results of his own study. Modell held steady, saying it was Heimlich who misunderstood the findings. It wasn’t a new dispute. In a 1981 article, written in response to a piece published earlier by Heimlich that cited a study co-authored by Modell, Modell wrote, “Heimlich has read into [my] article more than what was published.”

“I am convinced that significant blockage of the airway by free water during drowning is uncommon,” Modell added, noting that Heimlich’s claims that water “gushing” from the mouths of victims being treated with his maneuver is coming from the stomach in the majority of cases, not the lungs.

Heimlich, though, remained adamant, and began using high-pressure tactics in an attempt to get the AHA to adopt his procedure as the first response. The vitriol is reflected in a series of letters exchanged between Dr. Joseph Ornato, of the Virginia Commonwealth University’s Medical College of Virginia, and Heimlich. The letters, unearthed by Holly Martins, show just how much muscle Heimlich was willing to apply in an attempt to get his way.

Ornato insisted there was no scientific evidence justifying Heimlich’s claims regarding the effectiveness of his maneuver on drowning victims.

“Although your opinion about the need for your maneuver in cases of near-drowning is important and respected, in the opinion of the other panelists there is not yet adequate scientific proof that it is necessary, safe or effective,” Ornato wrote in an August 1985 letter to Heimlich.

In another letter, Ornato contended that what Heimlich presented were “anecdotes,” not “scientific proof.”

Heimlich responded by threatening to go to the media with claims that the same mistake made in regard to choking was recurring. He claimed that the Heart Association and Red Cross made a “scientific error” when they first initiated the use of CPR as the primary response in near-drownings in 1960, and that a cover-up was under way. “The scientific error of not evacuating water from the lungs, that dates back 25 years, must be admitted and corrected,” Heimlich wrote.

“Heimlich went nuts,” Ornato says.

Among other things, Heimlich wrote to officials at the Medical College of Virginia, where Ornato had just joined the faculty.

“He almost got me fired,” Ornato says. “The things he was saying about me were really slanderous.”

An inquiry eventually cleared Ornato of any wrongdoing. But it would not be the last time Heimlich would use such a tactic in an attempt to get what he wanted.

In the end, Modell, whom Ornato describes as a “god” in the world of drowning experts, suggested a compromise. It was decided that the revised protocol would keep CPR as the first response. Even though, as Ornato said, there was no scientific “proof” Heimlich’s maneuver actually cleared water from the airway — or that even doing so was necessary — the protocols were changed to state that the maneuver, referred to as an abdominal thrust (over Heimlich’s objection — he wanted this procedure to bear his name as well), could be used under certain circumstances.

The final revised protocol, printed the following year in the Journal of the American Medical Association, read:

“Since the risk-benefit ratio of a subdiaphragmatic abdominal thrust in this setting is unknown, the only time it should definitely be used is when the rescuer suspects that foreign matter is obstructing the airway or if the victim does not respond appropriately to mouth-to-mouth ventilation.”

Experts agree that both methods are likely to induce vomiting. If vomit is taken into the lungs, the resulting complications, because of the high acidity, can cause pneumonia, brain damage or even death. In the eyes of almost everyone except Heimlich, though, mouth-to-mouth was proven to be effective. But at the time the Heimlich maneuver was included in the protocols, there was only anecdotal evidence that it might be useful.

So, why include an unproven procedure that could be lethal?

Ornato says the panel was striving to keep an open mind. Heimlich had been right about the effectiveness of his maneuver on choking victims. Maybe he was right about this too.

Modell is more blunt. “Inclusion of the Heimlich maneuver in the 1985 protocols was a concession to Heimlich,” he says.

It was a concession, however, that he refused to be satisfied with.

The 1985 panel concluded that it was necessary to conduct a thorough study to determine the usefulness of the Heimlich maneuver in treating near-drowning victims. To that end, a University of Florida researcher proposed conducting a study using dogs. Modell would have played a role in the experiment. The plan was to anesthetize the animals and then put water dyed different colors into their lungs and stomachs. The Heimlich maneuver would be applied to determine how much water would be expelled from each organ. Twenty-two dogs would be involved; the cost was less than $15,000.

Animal rights activists learned — some say through Heimlich — of the plan and howled in protest. That isn’t unusual. What is odd is that Heimlich, who conducted experiments of his own on dogs in the 1950s, joined the raucous chorus of activists in an attempt to halt the study.

As activists staged rallies and made anonymous threats to the researchers, Heimlich held a press conference in Cincinnati, where he called the experiment “unnecessary and cruel.”

Ornato: “If I were Heimlich, I certainly would have let the study go forward. If you are proven right, then you have the strongest, most unbiased evidence available. To not let it go forward makes no sense at all.”

In a letter to university officials, Heimlich stated, “It is incomprehensible that even one dog would be purposefully drowned to carry out an experiment that has no significance, since the outcome has already been clinically proven and accepted after extensive peer review, including that of Dr. Modell.

“All scientists engaged in research are beholden to prevent unnecessary loss of life, both human and animal,” he continued. “To do otherwise is to jeopardize our right and privilege to conduct research. It is in this spirit that this letter is written.”

The protests and threats continued. One alumnus threatened to withhold a $300,000 donation to the university. The experiments were called off.

And Heimlich applauded.

“The whole thing was ill-advised, inaccurate and has no value to humans,” he told the Cincinnati Enquirer.

Stymied again

Six years later, the American Heart Association again held its national conference. This time, Dr. Linda Quan, a highly regarded drowning expert from the University of Washington, chaired the panel on near-drowning. It came to much the same conclusion as its predecessor:

“A Heimlich maneuver delays initiation of ventilation and breathing. Its value has not been proven scientifically and is supported only by anecdotal evidence, and its risk-benefit ratio is untested.”

Again, its use was recommended only if the rescuer “suspects that foreign matter is obstructing the airway or if the victim does not respond appropriately to mouth-to-mouth ventilation.”

According to Quan, Heimlich was invited to attend the conference, but didn’t show. His absence, however, didn’t stop him from lashing out again.

“He went to my university and accused me of scientific misconduct,” she says. “Basically he said I hadn’t used good science. They did an investigation and cleared me of any wrongdoing.

“I don’t think anyone takes him seriously,” Quan adds. “He has not produced any serious science.”

So why keep it in the protocol at all as a way to remove liquid from the airway?

“We wanted to remain open-minded,” she says.

At that point, no one was calling into question the veracity of the cases being presented, she adds.

Even in absentia, Heimlich and his reputation remained a forceful presence.

“We’ve gotten a whole lot smarter since then,” Quan says. “Just because someone has an M.D. or PhD behind their name and is saying that they saved X number of people last year, that’s not science. The bar is much higher now.”

The following year, a seven-member panel convened by the Institute of Medicine released the results of a study it had conducted into the use of the Heimlich maneuver on near-drowning victims.

Heimlich and Patrick made their case to the body. Again, they were less than convincing.

The committee found that “the available evidence does not support routine use of the Heimlich maneuver in the care of near-drowning victims” and recommended that abdominal thrusts be performed “only after ventilation has been shown to be ineffective and then only to remove a solid foreign body.”

Once more, Heimlich went on the attack, accusing committee chair Dr. Peter Rosen, of the University of California, San Diego, of scientific impropriety. He, too, was cleared by his university.

By 1995, Heimlich was continuing to take his case directly to the public, appearing on television shows and showing up frequently in newspaper articles. He usually found a compliant media. After all, this was Henry Heimlich, the man often credited with saving more lives than any other living human. And he made for a good story — the man who once before fought a lonely battle against a ponderous medical establishment only to come out on top was once again locked in a David vs. Goliath fight, refusing to give in to the naysayers.

As always, his approach remained typically heavy-handed. Chris Brewster, president of the U.S. Lifesaving Association, recalls seeing Heimlich speak to a large gathering of lifeguards in 1995.

“He was pretty amazing,” Brewster says. “Here’s this room full of lifeguards, many of them starstruck, and Heimlich is making an end run around the medical establishment. He took a guerrilla warfare approach.”

Although Brewster, a lifeguard since 1979 and chief lifeguard for San Diego for 13 years, found Heimlich’s idea intriguing, he also thought the doctor’s approach unethical.

“He was recommending that lifeguards ignore the established protocols that they’d been taught, and that seemed inappropriate to me.”

Brewster stood and raised the issue.

“Heimlich responded by saying, ‘You can have that opinion if you want. That’s what the Nazis said at Nuremburg, that they were just following orders.’”

That same year, Heimlich found a much more receptive audience in Jeff Ellis & Associates, a company that trains as many as 35,000 lifeguards a year for theme parks such as Disney World and Six Flags.

Ellis vice president Richard Carroll says the company viewed Heimlich as a kindred spirit. Both the company and the doctor were pioneers.

“That’s why we initially worked with Dr. Heimlich, even though it was a big controversy in the medical community,” Carroll says.

By 1998, company founder Jeff Ellis was boasting of the wonderful results.

“Three years of successful rescues affords Dr. John Hunsucker with enough data to issue a national report citing many of the statistics that critics maintain do not exist,” Ellis wrote in a newsletter. “Slowly, more and more folks are beginning to take notice that there is ‘something’ to using the Heimlich maneuver to aid near drowning victims.”

Hunsucker was an interesting choice to compile and analyze the data. Identified by Ellis as his “mentor,” Hunsucker was not a medical doctor, but rather a mathematician who taught industrial engineering at the University of Houston. Moreover, he, too, has a company that trains lifeguards. Hunsucker’s company also adopted using the Heimlich method as the first response.

Apparently, the comprehensive report promised by Ellis never appeared — at least never in any peer-reviewed scientific literature. Neither Ellis & Associates nor Hunsucker would provide the data to Metro Times.

Hunsucker did, however, have an article published in Splash, an industry trade magazine. In that article, Hunsucker reported that in 1995, Ellis lifeguards rescued 26 “non-breathers,” 21 of whom were “jump-started by the Heimlich.” The rest required subsequent mouth-to-mouth ventilation.

One of the great advantages of using the Heimlich maneuver, Hunsucker says, is that many lifeguards are reluctant to provide mouth-to-mouth resuscitation. The Heimlich maneuver can be employed without the risk of contracting an infectious disease.

“I’m not a physician,” Hunsucker wrote. “But on the other hand, I’m not stupid either. I can follow a logical argument when one is presented.”

And until someone convinced him otherwise, Hunsucker declared, he would continue to advocate using Heimlich first and mouth-to-mouth only when that didn’t revive the victim. “I’m a hugger,” he wrote, “and don’t kiss unless I have to.”

Hunsucker may continue to be a hugger first, but Ellis & Associates abruptly changed course in 2000, returning to its previous practice of having its lifeguards provide CPR first instead of abdominal thrusts.

Asked why, Carroll replies, “We don’t feel that straying away from the scientific community and the processes that have been recommended by them is providing any increased level of care.”

And what about Heimlich’s claim, posted on his institute’s Web site, citing statistics collected from 1995 to 2000 — apparently from Ellis — claiming that “152 unconscious, non-breathing drowning victims were resuscitated using the Heimlich Maneuver,” with a mortality rate of only about 3 percent? Carroll couldn’t confirm the exact numbers, but says the company has come to the conclusion that it’s not necessarily the Heimlich maneuver that contributes to the extraordinary success rate.

“We don’t think the data can say the Heimlich maneuver is unequivocally the reason,” Carroll says. “We could never draw that conclusion.”

More likely, he says, is the speed with which an Ellis lifeguard is usually able to get to a victim — often within 30 seconds.

As the Heart Association’s Hazinski points out, there is some research indicating that any sort of stimulation can be effective when response times are that quick.

Knocked back

Heimlich suffered another setback as well in 2000, when the American Heart Association once again convened a conference and considered its drowning protocols. This time around, it narrowed the parameters for use of the Heimlich maneuver even further, removing the “or if the victim does not respond to CPR” instruction. Now the only time use of the maneuver is called for is if the rescuer suspects a foreign object is blocking the airway. In other words, the Heimlich maneuver, after 15 years, is back to the only thing it has ever been proven to be truly effective for: saving someone choking on a solid object.

That news, apparently, never made it to the lifeguard treating Derrick Kelly the night he died at Eastern Michigan University.

Experts interviewed for this article, when provided with a scenario similar to that experienced in the Kelly case, say that the bloody foam that came pouring out was coming from his lungs — chlorine and other chemicals in the water damage the lungs and cause them to bleed — is a common occurrence in pool drownings. It also indicates his airway had been opened.

It is also usually a sign the victim is in grave jeopardy. Some caution that, no matter what was done at that point, chances were slim Kelly could have been revived.

Others disagree.

“Bloody foam is a classic finding, and you should never attempt to use the Heimlich maneuver to remove foam like that,” says Dr. James Orlowski, a drowning expert who says he has studies about 30 cases where use of the Heimlich maneuver has caused serious harm to near-drowning victims. “Not only does it do no good, you are delaying what the victim needs, which is breathing.”

Also, there is the threat the maneuver will provoke vomiting.

Modell makes a similar observation, saying, “There is no evidence that the Heimlich maneuver is effective in clearing the airway of liquid and improving the chances of survival.

“Clearly, if a person has a chunk of meat stuck in their voice box, the Heimlich maneuver is wonderful. But he should have stayed with that.”

Then why did the AHA ever include it at all?

For one thing, there were those five case reports, says the Heart Association’s Hazinski. Although considered a “very low level of evidence,” she says, they couldn’t just be ignored. And the parameters for its use, she insists, “were very narrow.”

“We’re all getting smarter about evidence evaluation,” Hanzinski adds. “It has evolved to be much more rigorous and much more critical than it was 15 or 20 years ago. It’s been an evolution in the medical community as a whole.”

Brewster, president of the lifeguard association, has a different view.

“When you look historically at how this unfolded, I don’t think the medical establishment did a very good job of dealing with this issue,” he says. “They were fighting this persona of Henry Heimlich who, in the public mind, is an icon of medicine. He’s a very good advocate, and obviously tenacious. And he kind of bullied these other doctors into going along with him.”

The situation grows even darker now that the cloud of alleged fraud has formed.

Fraud squad

In September 2003, Holly Martins e-mailed the presidents of the American Heart Association, American Red Cross, the Institute of Medicine and the National Academy of Sciences, alleging that Heimlich and his longtime associate, Dr. Edward Patrick, “fabricated medical case reports” to get the Heimlich maneuver established as the primary drowning response within the mainstream medical community.

None of those organizations followed up on the complaint. All say they aren’t designed or staffed to investigate such allegations.

But others are acting.

“Recent information provided us has raised questions regarding the factual basis of [two] cases you have cited that purport to show the efficacy of the Heimlich maneuver for drowning,” wrote U.S. Lifesaving Association medical director Dr. Peter Wernicki in an April 2004 letter to Heimlich and Patrick. Because references to those cases were printed in the association’s magazine, Wernicki wrote, “We have an ethical obligation to investigate and correct the record.”

Heimlich responded with a four-page letter that, according to Wernicki, “didn’t give us any answers at all.”

Things may be getting particularly hot for Patrick, who, like Heimlich, denies any wrongdoing. In an exposé for the alternative newspaper Cleveland Scene, reporter Thomas Frances found considerable evidence indicating Patrick never completed the residency training that should have been required for him to obtain his medical license. That article raised enough doubt for the Heimlich Institute to ask Patrick to provide documentation verifying his status. Or so they say.

“That’s news to me,” Patrick said in response to an e-mail query from Metro Times.

Patrick never responded directly to Wernicki’s letter. He recently posted some information on the Web site of his Patrick Institute, but the documents lack most of the information Wernicki was seeking, evidence that would verify Patrick’s account of a 1980 near-drowning that occurred in Lima, Ohio.

In addition, a Philadelphia alternative newsweekly following up on the Scene article has reported that a doctor Heimlich and Patrick claim conducted a peer review of the Lima incident denies having ever verified Patrick’s account.

Also, Metro Times has verified that in 1981, a fraudulent letter was sent to a magazine for emergency medical technicians falsely claiming that the Heimlich maneuver was used to save a two-year-old drowning victim in the small central Pennsylvania town of Dallas near Wilkes-Barre.

What we found is as nefarious as it is bizarre.

In July 1981, Heimlich wrote an article promoting the use of his maneuver for use in near-drownings for the magazine Emergency Medical Services. (Heimlich also served on the magazine’s board of directors.) The next issue of the magazine contained the following letter:

“Your article concerning the ‘Heimlich maneuver: First Treatment for Drowning Victims,’ was the topic of discussion at our August crew meeting and the next day was used on a two-year-old drowning victim. The child had been submerged in a swimming pool for 10 minutes. Upon removal from the water, he had no vital signs and his pupils were dilated and fixed. The Heimlich maneuver was used immediately and approximately two cups of water were expelled from his airway. CPR was initiated and continued for 10 to 15 minutes before the child was resuscitated. He has since fully recovered with no ill-effects. We would like to compliment you on your excellent presentation as well as the quality material presented in your magazine.

Dallas Ambulance Squad

Dallas, PA

Seven years later, in August 1998, Heimlich used the letter to help substantiate claims of the maneuver’s effectiveness in an article he wrote for the publication Postgraduate Medicine, and later referenced it as supporting material in a report he provided to the Institute of Medicine when it was conducting a comprehensive study to evaluate the merit of the maneuver in drowning cases.

An August 1981 story in the Dallas Post indeed describes the near drowning of a 2-year-old boy in his family’s pool. The article makes no mention of the Heimlich maneuver being used, but does name the emergency medical technician, Robert Besecker, who saved the boy. It turns out he was the child’s uncle. In a phone interview, he confirmed the newspaper account of the event, and was adamant that the Heimlich maneuver had not been used.

“I didn’t even know then that the Heimlich maneuver could be used in a drowning case,” he said.

Asked if it was possible that another 2-year-old had also nearly drowned that same month, he said he was certain that could not be the case. Dallas is a very small town, he explained, and he certainly would have been aware of another such incident. Drownings are extremely rare, he said, with the ambulance company responding to them only once every five years or so.

Obviously, someone cared enough about advancing the cause of the Heimlich maneuver to lie to emergency personnel. The only question now is, who?

Heimlich’s odd maneuvers

In addition to all this are other maneuvers taken by Heimlich in recent years that sound increasingly bizarre. None is more controversial than his contention that infecting people with malaria may provide a cure for cancer, Lyme disease and AIDS.

In fact, he participated in a study in China that involved deliberately infecting a small group of AIDS patients with the fever-inducing disease on the theory that it helps stimulate the body’s immune system.

Heimlich, who has no training in immunology, has been promoting the idea since the early ’90s. In 1994, the Los Angeles Times reported on Heimlich reeling in tens of thousands of dollars at a star-studded Hollywood fundraiser.

Despite a unified outcry from leading AIDS researchers, Heimlich had no problem getting celebrities to buy into his theory. As one supporter told the Times, “His name carries a lot of weight. For many of us in the entertainment industry, meeting him was like meeting Albert Schweitzer. And sure, that affected our generosity.”

Heimlich used the money to fund a study in China where 12 men afflicted with the AIDS virus were infected with malaria in what was termed a pilot study, The New York Times reported last year.

The Centers for Disease Control issued a memorandum saying the practice “cannot be justified.”

For Dr. Robert Baratz, who heads the National Council Against Health Care Fraud, the AIDS work, which would not be allowed to take place in this country, and Heimlich’s insistence on using his maneuver to resuscitate drowning victims, are part of the same pattern. Neither has a basis in science, he says, yet Heimlich persists. Classifying the doctor’s actions as “delusional,” Baratz says Heimlich’s actions fit into a classic pattern of fraud: “He’s preying on victims.”

Such criticism has never had much effect on a man who has generated controversy throughout his career. As a glowing profile in the Saturday Evening Post pointed out, Heimlich’s motto is, “If all your peers understand what you’ve done, then it isn’t creative.”

But, just as there is a fine line between genius and madness, so too is the line between creation and destruction.

Controversy comes at a cost. The question is, who winds up paying in the end?

Curt Guyette is Metro Times news editor. Contact him at 313-202-8004 or cguyette@metrotimes.com.

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