The Trouble With Henry (Controversy About Heimlich for Drowning and Asthma Victims)

Metro ^ | January 6 | Shane Johnson

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Controversy doesn't deter prominent doctors from hailing the enigmatic Dr. Heimlich

SINCE CO-DISCOVERING the "sub-diaphragmatic thrust" in 1974, Dr. Henry Heimlich's namesake maneuver has irrefutably saved the lives of thousands of choking diners the world over. But despite dogged self-promotion, Heimlich's subsequent medical maneuvers have been thoroughly panned by the medical intelligentsia.

Along the way, the 84-year-old Cincinnati-based thoracic surgeon has allied himself with a small band of respected medical professionals, including the director of the Salt Lake County Health Department from 1971 to 1993, Dr. Harry Gibbons. The two met in 1974 when Gibbons, an aerospace physician by trade, called on Heimlich's tutelage after a rash of high-profile choking incidents in Salt Lake City. Together they launched the nation's first citywide Heimlich Maneuver education campaign, laying the groundwork for the maneuver's eventual canonization in the American Heart Association's Standards and Guidelines for choking in 1986.

Yet, despite controversy, Gibbons has backed Heimlich's myriad medical pursuits since then, even as they've been deemed scientifically irrational and dangerous by experts in the fields of drowning, asthma, AIDS, cancer, Lyme disease and, ultimately, medical ethics.

Quick on the heels of his triumph with the choking maneuver, Heimlich went to work on replacing cardiopulmonary resuscitation (CPR) as the first-response protocol in near-drowning cases. Heimlich contends that mouth-to-mouth resuscitation is useless without first plying his maneuver to remove trapped water from drowning victims' lungs. Despite disagreement from virtually every reputable medical organization in the country, Heimlich continues to unabashedly assert on his website, www.heimlichinstitute.org, and elsewhere that the American Heart Association and the American Red Cross "are endangering lives by advocating CPR before the only method that has been proven to save lives, the Heimlich Maneuver for drowning."

Citing a concerted "smear campaign" against Heimlich in the press, his spokesman declined an interview request.

For his part, Gibbons said resistance to Heimlich's drowning protocol is politically motivated, just as it was when they fought for more than a decade to get the maneuver approved for choking.

"They're looking for anything they can push you down with," said Gibbons, who advocates the maneuver for drowning in contravention of national standards. "A lot of we doctors, if it's something that we didn't invent, we're envious, and we tend to attack things."

Retired U.S. Coast Guard Rear Adm. Alan Steinman, the Stanford-trained M.D. who devised the current drowning resuscitation guidelines for the armed forces, said it's not bad blood but bad science that's done in the Heimlich for drowning.

"The entire premise of Dr. Heimlich's hypothesis is wrong," Steinman said in a telephone interview from his home in DuPont, Wash. "The lungs are not filled up with water in drowning. Any water that gets down into the airway and lungs is rapidly absorbed.

"There's absolutely no basis whatsoever for advocating the Heimlich maneuver in resuscitation of near-drowning victims. In fact, it's counterproductive and dangerous."

Notes Dr. James Orlowski, a drowning expert and chief of pediatrics at University Community Hospital in Tampa, Fla.: "None of [Heimlich's] cases have been adequately enough documented for the scientific community to look at them critically."

Furthermore, Orlowski said he's investigated 30 near-drowning cases where the maneuver is suspected of causing severe physical harm. The injuries range from damage to the pancreas and stomach ruptures to documented cases of aspiration pneumonia—where he said the Heimlich Maneuver induced vomiting, which was then inhaled into the lungs during resuscitation. And counter to Heimlich's claims, even if there is fluid in the lungs, it's well understood that "you can very easily ventilate or breathe through that fluid with no trouble at all," Orlowski said.

Overt dangers aside, Orlowski said the gravest consequence of using the Heimlich is that it unnecessarily wastes precious seconds in getting air into a drowning victim's lungs.

Prevailing science hasn't swayed Dr. Glen C. Griffin, though. A longtime associate of Drs. Gibbons and Heimlich, Griffin endorsed and published Heimlich's drowning protocol in two McGraw-Hill medical journals, of which he was editorial director until 1995.

Of a handful of anecdotal cases presented by Heimlich in Griffin's journals, and which he still touts, two have since been discredited to varying degrees. In one case, the man who purportedly revived a near-drowning victim using the Heimlich in 1981 recently told the Detroit Metro Times that he in fact resuscitated the victim, his nephew, with CPR alone. Another questionable case involved Heimlich's one-time colleague and close friend Dr. Edward Patrick, also the self-reputed co-discoverer of the maneuver. As recently reported in the Cleveland Scene, Patrick claimed to have been working as an attending physician in a Lima, Ohio, emergency room when he purportedly used the maneuver in 1980 to resuscitate a child who nearly drowned in a nearby lake. However, Patrick has refused reporters' requests to provide proof that he was employed at Lima Memorial Hospital at the time of the scantly documented case, in which the 2-year-old girl slipped into a coma and died some months later.

Since Griffin left McGraw-Hill, both journals have published articles against use of the maneuver for near-drowning cases. One such article in a 1998 edition of Physician and Sportsmedicine advised that the Heimlich "is of unproven benefit and should not be used unless obstruction of the airway is strongly suspected."

Still, Griffin and Gibbons swear by it. "The logic of water going down an airway and pushing it out is so consistent with what makes sense that I just cannot imagine anybody not thinking that this is a good idea," Griffin said. Asked how he can maintain that position in the face of near-universal opposition within the medical community, he argued that "it might be universally acceptable, or a good idea to do abortions, or a whole bunch of other things that medical committees ... or others think is a good idea, and they're not."

Although Gibbons acknowledges "there's sure a lot that I don't know" with respect to the science of the drowning maneuver, he notes there was "very little scientific evidence to back up the [Heimlich Maneuver for] choking, too, which of course gives you some encouragement."

So confident has Gibbons been in Heimlich's work that in the late '80s he tapped professional contacts in Mexico City, paving the way for Heimlich's infamous "malariotherapy" treatments on terminal cancer patients. Heimlich has postulated for decades that malaria-infected blood can arouse the immuno-defenses of cancer, Lyme disease and HIV/AIDS sufferers. The Food and Drug Administration, Centers for Disease Control and World Health Organization have rejected the science outright. Ethicists have likened malariotherapy to Nazi-era medicine.

Gibbons concedes that the malariotherapy trials were conducted south of the border "because you could do it in Mexico." And although he's sat on two institutional review boards—medical panels that inspect and monitor clinical research protocols—that he said wouldn't have approved the malaria tests, he nonetheless "thought it was worth a try," given that the dying patients had no other options.

Gibbons reported that one woman's rectal tumor showed signs of retreat after being injected with malarial blood. But the study's potential was never realized, he said, because Mexican officials "kicked [Heimlich] out" after a journalist reported that American doctors were using Mexicans as "guinea pigs."

Undaunted, Heimlich has continued his malariotherapy foray on AIDS patients in China, and possibly in sub-Saharan Africa, according to published reports. But it appears that media scrutiny has hushed Heimlich, who was dis-invited from a 2004 Pan Africa AIDS conference where he was supposed to discuss the controversial therapy. Additionally, the Heimlich Institute, which is hosted by Deaconess Hospital in Cincinnati, Ohio, has recently removed from its website references to Heimlich's ongoing malariotherapy efforts.

Naysayers haven't stopped Heimlich, or Gibbons for that matter, from touting the unproven efficacy of the Heimlich Maneuver for yet another ailment. According to Heimlich's website, the maneuver can also relieve acute asthma attacks by expelling trapped air and mucous plugs in asthmatics. And as a preventative tool, administered routinely as "mini-Maneuvers," Heimlich claims his "cost-effective" treatment reduces the likelihood of acute attacks, and "often eliminates or diminishes the need for anti-asthma medications which have serious, even fatal, side effects."

In many ways, Heimlich's asthma pitch is reminiscent of his malariotherapy promotions. In emails to the Los Angeles Times in 2003, Heimlich claimed that "malariotherapy offers a safe, promising and inexpensive way to help the millions of people suffering from AIDS through the underdeveloped world."

Heimlich, who hasn't held a license to practice medicine in Ohio since 2002, told a reporter last year that studies are currently under way to demonstrate the benefits of the maneuver for asthmatics.

In both cases, said medical ethicist Elizabeth Woeckner, a board member of the national nonprofit group Citizens for Responsible Care and Research, Heimlich "puts the cart in front of the horse."

"If you're conducting research and you're already telling me the results—that it is effective and it works—why the hell are you doing the research?" asks Woeckner, who has investigated the protocols used in Heimlich's malariotherapy trials, which in 2000 the national Food and Drug Administration said were "inadequate" and failed to "minimize risks to subjects."

Woeckner further states that Heimlich's asthma push hasn't even made it to "first base," ethically speaking, because he has yet to demonstrate that current asthma treatments are lacking, let alone how his maneuver would fill the perceived void. "Do the experts in the field have any doubt which of those two treatments is better?" she said. "They have no doubt.

"This is why you do research, not because you have—excuse me—a bug up your ass."

Heimlich's poster child for the asthma maneuver—a 12-year-old Kaysville, Utah, girl featured prominently in a testimonial on his website—happens to be the granddaughter of a "dear friend" of Dr. Gibbons, who vouches for the maneuver, and teaches it whenever he has the opportunity.

Gibbons said he's petitioned pulmonolo-gists at Primary Children's Medical Center to consider testing the Heimlich on asthmatics, but they "would not even discuss it," he said. "And that's pathetic."

Loren Greenway, administrative director of respiratory and pulmonary medicine for Intermountain Health Care, and a nationally certified asthma educator, finds Heimlich's asthma maneuver physiologically unfounded and dangerous.

"Using the Heimlich maneuver in an acute asthmatic condition ... could actually kill somebody," said Greenway.

Peter Heimlich, Dr. Heimlich's son, began examining his father's career a few years ago and, based on what he found, has joined the ranks of those calling for an end to the elder Heimlich's quixotic medicine.

"My father is enormously charismatic and persuasive," Peter Heimlich says "People trust him because the maneuver for choking has saved so many lives. [But] after a 30-year campaign, he hasn't convinced a single drowning expert," Peter says. "It doesn't seem to bother him that people may be hurt or killed. The whole thing's tragic and sick."

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