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Henry Heimlich’s Maneuvers – Hero or Charlatan?

April 20th, 2014

Was Heimlich Wacky or Misunderstood in Later Years with “Malariotherapy”?

Son Peter Reports Heimlich is a Fraud Who May Not Even Have Invented Famous Choking Rescue

Red Cross Still Insists Back Slaps Are the Answer

NPR’s Radiolab drew attention last year (November 2 2013) to the Heimlich saga. The hero who invented the way to expel lumps of food lodged in the windpipe by embracing the suffocating victim from behind and jerking one’s fists into his or her diaphragm became a household word with the success of his advice worldwide, where it has saved countless victims from dying in restaurants, including Goldie Hawn and other celebrities.

Unfortunately Heimlich apparently went somewhat wacky in his later years. Among other ideas he suggest extending the Heimlich maneuver to drowning victims, asthma sufferers, cystic fibrosis, and using malaria to accelerate the immune system to then expel the so-called AIDS virus from the system. Critics answered that this would only induce the waterlogged to swallow their own vomit, without clearing their lungs (which reportedly do not contain much water), and the procedure would be similarly useless in clearing the lungs of asthma and cystic fibrosis mucus.

Eminent authorities in the field of AIDS such as Dr Anthony Fauci of NIAID dismissed the malaria therapy as “atrocious”. Such was the disapproval from the medical establishment and their allies of his latter day initiatives that the American Red Cross made banging choking victims on the back five times a priority before attempting the Heimlich maneuver, which they relabeled “abdominal thrusting”.

Even one of Heimlich’s sons, Peter, turned against him, though the other, Phil, supported him, saying that the old belief that thumping on the back would only lodge morsels deeper in the bronchial tract was true and supported by studies. But the result is that Heimlich, while still a household name, has lost some of its luster.

How much truth there is in all this is interesting to examine. Wiki of course mirrors the established attack line, but one wonders what the reality is. For a start, it appears that the Red Cross has always been upset with Heimlich for saying that their long time teaching to use chest compression was useless, and might break bones in the elderly. Heimlich refuted the American Red Cross move to prioritize back slaps, and told them to remove his name from their instructions on abdominal thrusting.

Heimlich’s autobiography flops

Heimlich’s autobiography was published in paperback this year (Prometheus, 253 pp, Feb 11) and contained much information on his other “creative problem-solving”, according to Booklist:

From Booklist
Henry Heimlich has saved many lives and made it possible for nearly everyone, even children, to save a life and be a hero. In 1974, he introduced the Heimlich Maneuver, an uncomplicated technique for treating victims of choking. But his creative problem-solving extends beyond obstructed airway passages. Heimlich is a real-life medical version of TV’s MacGyver. While stationed in the Gobi Desert during WWII, he devised a simple cure for trachoma (a leading cause of blindness) by mixing pulverized sulfa antibiotic tablets with shaving cream. He has devised an operation that fashions a new esophagus by using a portion of the stomach, invented a chest drain valve that is used in the treatment of collapsed lungs, and developed a device that aids in the delivery of supplemental oxygen. In his uplifting memoir, the retired thoracic surgeon and medical innovator comes across as a man with big ideas and lofty ideals, a caring physician who combines common sense and knowledge to make the world a safer place. –Tony Miksanek .

It boasted only a few pre-publication blurbs from a well known name – Neil Armstrong – and medical sources:

“As White House physician, I performed the Heimlich Maneuver on a choking guest in the State Dining Room at a holiday reception during the final year of President George H. W. Bush’s term in office. Years later, at the Mayo Clinic, I performed the maneuver on a choking staff member. Thank you, Dr. Heimlich, for inventing this lifesaving method that has allowed me to save two lives. This memoir is a must-read for all who want to know about your amazing life and many contributions to medicine.”
—Connie Mariano, MD, former White House physician (1992–2001), author of The White House Doctor: My Patients Were Presidents

“With compassion and an amazing ability for getting to the essence of problems, Dr. Henry J. Heimlich has saved countless lives. And, as we learn in the pages of this remarkable book, no one has ever lived a life remotely like the inspiring journey that has been Dr. Heimlich’s. I recommend that every medical student, every doctor, and everyone who needs to see the potential of the human spirit read this wonderful book and take its lessons to heart.”
—Neal Barnard, MD, founder and president of the Physicians Committee for Responsible Medicine

“From northern China in World War II to the laboratory, to the operating room, and to medical conferences around the world, surgery has been the life of Dr. Henry J. Heimlich. In Heimlich’s Maneuvers, Hank recounts the challenges, controversies, and successes of his more than half a century working at the edge of medical knowledge.”
—Neil Armstrong

“[Heimlich’s] ability to find innovative and surprisingly simple solutions to seemingly insurmountable problems has saved countless lives.”
—Physicians Committee for Responsible Medicine 2010 Award for Innovative Medicine

Apart from a five star rating by one Himri (am “engineer” from Arizona) – “Wow, magician of the human body” – a few days ago the paperback seems to have aroused no enthusiasm among readers and no media reviews except from Booklist.

Evidently the attack on his reputation seems to have scotched the success of the book. Certainly there have been few more lethal sounding patricides that his son’s (read it below).

We are still trying to get to the bottom of this story, which is surely one of the most striking examples of reputation demolition in the history of science. Perhaps you can do better.

Links to explore

Heimlich in WQiki
Medline Heimlich/000047.htm
Heimlich on Why Malariotherapy Makes Sense by Boosting Immunity with Weak Malaria
ABC and Fauci on Why Malariotherapy Might Kill You
Save A Life Abandons Heimlich
Heimlich Fights The Red Cross Backsliding

CINCINNATI (January 21, 2013)– Since inventing the Heimlich maneuver in 1974 with a team of Jewish Hospital researchers, Dr. Henry Heimlich claims the procedure and its abdominal thrusts — into the stomach above the navel and up against the diaphragm to force air from the lungs and remove obstructions — have saved the lives of 100,000 potential choking victims. And yet the American Red Cross’ first-aid procedure recommends five back slaps and then five abdominal thrusts for someone who’s choking.

Those recommendations “horrify” Heimlich. “There has never been any research saying the back slap saves lives,” he said. “We know the Heimlich maneuver works. So it comes down to a matter of life or death.”

Choking is deadly. The National Safety Council lists choking as America’s No. 4 cause of accidental death behind poisoning (35,600 deaths annually), vehicles (35,500) and falls (28,000). In 2010, the most recent year for which statistics have been compiled, choking claimed 4,700 lives, a 4 percent increase over 2009.

Heimlich believes some of those lives could have been saved by his maneuver versus slapping someone on the back.

“I don’t want to fight the Red Cross,” he insisted. “But I don’t want people dying needlessly.”

Heimlich has asked the Red Cross to produce research showing the effectiveness of back slaps over his maneuver. If the nation’s traditionally final word in first aid can’t put up, he wants it to shut up. Stop telling people to slap choking victims on the back, he says. Tell them to use the Heimlich maneuver.

“There is no evidence whatsoever that hitting someone on the back helps a choking person,” Heimlich said. “Many scientific studies” have proven “if a person is choking and the food is in the airway, if you hit them on the back, it causes the food to go deeper and tighter into the airway.”

Heimlich has tussled with the Red Cross before. The Washington, D.C.-based first-aid and disaster relief organization has gone back and forth over the years on endorsing the Heimlich maneuver.

This waffling has vexed the Ohio thoracic surgeon, prompting him to ask the Red Cross to remove his name from any of its literature and training procedures on choking.

“When they started calling for back slaps first and then the Heimlich maneuver,” he recalled, “I wouldn’t let them use the Heimlich name. Why? Because patients were going to die.”

Heimlich has also been at odds with the Red Cross over his claims that the maneuver could help drowning victims and someone suffering an asthma attack. Researchers have seriously questioned both of those claims.

Now, at the age of 92, writing his memoirs, the doctor plans to appeal to the Red Cross one last time.

Turns out, Heimlich’s timing is impeccable. The Red Cross is conducting its semiannual evaluation of the scientific research behind its guidelines for providing first aid to choking victims. The report is due Saturday.

It also turns out, however, that the research Heimlich seeks doesn’t exist.

“To the best of my knowledge, after doing a pretty thorough literature search, no controlled studies exist comparing back blows to abdominal thrusts or anything else,” said Dr. Richard M. Bradley, a member of the Red Cross’ Preparedness, Health and Safety Services advisory council and an associate professor of emergency medicine at the University of Texas Medical School at Houston.

An independent source concurs. “The literature says there is no one definitive treatment to relieve an obstructed airway on a conscious person,” said William Terry Ray, director of the University of Cincinnati College of Nursing’s Nurse Anesthesia program. He looked at 40 years of research. The reviews concluded “a person may have to use the back blows as well as abdominal thrusts to relieve the obstruction, depending on what caused the person to choke.”

No definitive study exists to support Heimlich’s theory that slapping someone on the back can push an obstruction further down the throat. “The literature on this is not conclusive either,” Ray noted. Studies cited in a review of research projects “used animals, cadavers and anecdotal evidence.” But not living human subjects.

Matt Huesman, who used the Heimlich maneuver in August on a choking victim at his restaurant, planned to continue using the Heimlich maneuver over slapping someone on the back. He questioned science’s lack of progress.

“The Heimlich maneuver has been around for a long time,” he said. “Maybe it’s time somebody got on it and did that definitive study.”

Bradley agrees. But he knows that’s not where the grant money is. Choking happens outside of laboratory and research hospital settings, he noted. “Not enough dollars go to out-of-hospital research.”

Nevertheless, choking remains a killer.

“Anytime something is in the top five,” Bradley admitted, “it is a priority for research.”

Peter Calls Father Spectacular Liar and Fraud:

Peter Heimlich the disaffected son

In Spring 2002, my wife Karen and I began researching the career of my father, Dr. Henry J. Heimlich of Cincinnati, famous for the “Heimlich maneuver” choking rescue method. To our astonishment, we inadvertently uncovered a wide-ranging, unseen 50-year history of fraud.

Our research revealed my father to be a spectacular con man and serial liar, arguably one of history’s most successful – and destructive – medical humbugs. Armed with considerable charm, an instinct for public relations, and fueled by a ravenous need for attention and adulation, my father used the media to pass himself off as a medical genius/inventor and humanitarian, eventually being crowned “America’s most famous doctor” (The New Republic).

Contrary to his public image, my father was an incompetent surgeon – fired for misconduct from his last medical job in 1977 – who appropriated ideas from other doctors and attached his name to them. Facts indicate that he probably didn’t even invent what came to be known as “the Heimlich maneuver.” In my opinion, the only thing my father ever invented was his own mythology….

For example, the use of the Heimlich maneuver to resuscitate drowning victims has been warned against as useless and potentially lethal by the National Academy of Sciences, the American Heart Association, the American Red Cross, the US Department of Health and Human Services, and other organizations. Nevertheless, for decades the Heimlich Institute put the public at risk by promoting this and my father’s other dangerous medical recommendations.

As we came to understand, my father simply dreamed up these claims, then promoted them in journals and the popular media using evidence that ranged from shabby to fraudulent. For example, we researched a string of case reports in which he claimed drowning victims had been miraculously revived by the Heimlich maneuver. They’re all phony. The results? Dozens of serious injuries and deaths, including children.

Heimlich Institute Video Celebrating Heimlich’s Life and Achievement

Peter Heimlich’s Blog Undermines Forthcoming Father’s Autobiography and Radiolab Report

PDF of Peter Heimlich’s Letter Detailing Radiolab Misreporting

The above two links appear to show fine investigative work in medicine and science pursued to its full extent by Peter Heimlich in challenging ill founded initiatives and claims, without mercy for his father. The thorough performance reminds us of the celebrated Serge Lang of Yale, and is probably similarly discounted as extreme and needlessly discomfiting by his targets, who would probably claim that compromising with perfection is an inevitable part of reporting and story telling, as it is in any other human activity.

The autobiography of his father which was in the works at the time of writing and appeared in February is bounded to be – as far as Peter Heimlich was concerned – a whitewash that omits many of the embarrassments that he has pointed out.

Wednesday, October 30, 2013
After years of delay (and a canceled contract), Prometheus Books is publishing my father’s autobiography — here’s a preview
Via Heimlich’s Latest Maneuvers by Cleveland writer Mary Mihaly in Health Monitor, December 2009/January 2010:

Dr. “Hank” Heimlich may be the most famous doctor in the world…Inevitably, talk turns to his “latest maneuver”- his upcoming autobiography, Heimlich’s Maneuvers, to be published shortly by Bartleby Press.

The book never appeared, so presumably Bartleby preferred not to publish.

Four years and another publisher later, the wait may be over.

According to Amazon, my father’s 230-page autobiography is scheduled to be released by Prometheus Books, based in Amherst, New York, on February 11, a week after his 94th birthday.

Last week at the Cincinnati/Northern Kentucky International Airport (source)

Here’s the Table of Contents which I received from Lisa Michalski, Senior Publicist at Prometheus:

Foreword by Guy Carpico
Author’s Note
Acknowledgments
CHAPTER 1: Heeeeere’s Heimlich!
CHAPTER 2: My Beginnings
CHAPTER 3: The Depression, Anti-Semitism, and Visits to Sing Sing Prison
CHAPTER 4: Medical School Challenges and a Strange Internship
CHAPTER 5: En Route to China
CHAPTER 6: A Health Clinic in the Gobi Desert
CHAPTER 7: A Medical Newbie Searches for a Surgical Residency
CHAPTER 8: Saving a Life and Finding Love
CHAPTER 9: Restoring the Ability to Swallow: The Reversed Gastric Tube Operation
CHAPTER 10: Taking the Reversed Gastric Tube Operation behind the Iron Curtain
CHAPTER 11: A Promise to a Dead Soldier Kept: The Heimlich Chest Drain Valve
CHAPTER 12: A Boy Named Hayani
CHAPTER 13: Saving the Lives of Choking Victims: The Heimlich Maneuver
CHAPTER 14: The American Red Cross and Back Blows
CHAPTER 15: The Gift of Breath: The Heimlich MicroTrach
CHAPTER 16: Making the Most of Good Ideas
CHAPTER 17: Working toward a Caring World
Notes
Index

Hey, where’s “malariotherapy,” the notorious human experiments conducted for decades by Cincinnati’s Heimlich Institute in which U.S. and foreign nationals suffering from cancer, Lyme Disease, and AIDS were infected with malaria, resulting in investigations by three federal agencies and UCLA?

And I don’t see a chapter heading about my father’s decades of relentless campaigning to promote the use of the Heimlich maneuver to revive near-drowning victims, a depraved crusade based on dubious case reports that resulted in who knows how many dead kids.

How about when he was dismissed as Director of Surgery at Cincinnati’s Jewish Hospital in May 1977? Does he tell about the outrageous episode that precipitated his firing? That would probably increase sales.

What about his close relationships with doctors who lost their licenses for massive overprescribing of narcotics? One was Marilyn Monroe’s Dr. Feelgood and two did jail stretches. Wouldn’t that make a lively chapter?

And Chapter 8’s “Finding Love,” does that refer to his marriage or to his reckless sexual promiscuity, some of which my mother, the late Jane Heimlich, shared in her memoir?

And what about the late Edward A. Patrick MD PhD, my father’s 30-year colleague and co-author?

During his singular career, Dr. Patrick obtained a string of state medical licenses using squiffy credentials provided by my father, was involved in every aspect of the Heimlich maneuver, and, per his full-page obituary in the March 13, 2010 British Medical Journal, claimed to be the uncredited co-developer of the treatment — which he called “the Patrick-Heimlich maneuver.”

source
I asked Ms. Michalski, who replied:

There is no mention of Edward A. Patrick.

Wha?

How about my father’s widely-published claim that in 2001 he rescued a choking victim at a Cincinnati restaurant by performing “the Heimlich maneuver”? That’s a headline-maker sure to sell plenty of copies.

Via Ms. Michalski:

We have not found any mention of a 2001 incident of Dr. Heimlich saving someone with the Heimlich maneuver in a Cincinnati restaurant.

Ruh-roh.

Then there’s this March 16, 2003 front-page Cincinnati Enquirer article:

For more than 40 years, Cincinnati icon Dr. Henry Heimlich has been taking credit for a world-famous operation that was actually developed first by a Romanian surgeon behind the Iron Curtain.

In interviews, biographies and promotional materials, Heimlich has told anyone who would listen that he performed the world’s first total organ replacement. But even before Heimlich wrote his first article about the “Heimlich Operation” on dogs in 1955, the procedure had been performed dozens of times on humans by Romanian surgeon Dr. Dan Gavriliu, an Enquirer investigation has found.

Gavriliu now calls Heimlich a “liar and a thief.” He says Heimlich not only took credit for the operation, but also lied when he said they co-authored a paper for an international surgery conference.

…”Let Heimlich be a pig if he wants to steal an operation and put his name on it,” says retired New York surgeon Eugene Albu. “He changed the name from the Gavriliu Operation to the Gavriliu-Heimlich Operation. Then it became the Heimlich Operation later on.”

Six years later, from the 2009 article about the (aborted) Bartleby book:

Among other highlights, the book recounts how, in 1953, Dr. Heimlich launched his career by creating a surgical procedure for replacing the esophagus….

So which version is Prometheus running with?

Ms. Michalski:

Dr. Heimlich does credit Dr. Dan Gavriliu, in fact, it’s the basis of chapter 10, “Taking the Reversed Gastric Tube Operation behind the Iron Curtain.” According to the manuscript, Dr. Gavriliu had been performing the operation since 1951 (Heimlich first performed it in 1955).

Finally, here’s her reply when I asked for the name of the Prometheus editor responsible for the content and accuracy of the book:

Our authors are, first and foremost, responsible for the content of their books. During the production process, if the editors working on the book have questions about accuracy, clarity, sources, or the like, these are sent to the author for review and response.

Psst, a word to the wise for those editors….

Re: “questions about accuracy, clarity, sources, or the like,” I have a pretty good idea what’s in these chapters:

CHAPTER 6: A Health Clinic in the Gobi Desert
CHAPTER 11: A Promise to a Dead Soldier Kept: The Heimlich Chest Drain Valve

I’d strongly recommend you ask my father to provide you with a release to obtain his service records from the United States Navy.

And I’ll bet you a Heimlich valve that he won’t.

As in all things in humans and science all this discussion is a mixture of logic and emotion, with the latter not lacking in this arena.

Anyone who can throw further light of what seems to be a dismal end to a life as one of the most famous names in medicine, please comment.

Update: On Feb 6 Sat 2016 1pm RadioLab on NPR in New York (WNYC 94.0 FM) ran a repeat of the segment dating from 5pm Tuesday, March 05, 2013 now to be found at this page The Man Behind the Maneuver covering all this material very well but similarly undecided in the end as to whether the Red Cross advice to thump chokers on the back five times before using the Heimlich approach (which they now refuse to label as such) is valid or simply a defensive undermining of an innovator, which latter theory we are inclined to believe given the physics involved, which would suggest that thumping would send the obstruction further down the throat. But we await any correction on that speculation too.


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