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Heimlich Manuevers

DOCTOR RESPONDS TO CRITICS

Ed. Note: The following is an expanded version of the letter published in the May/June 2004 issue.

In his article about me, Brad Herzog questions the value of the Heimlich Maneuver to save drowning victims, but omits scientific facts that say otherwise ("Dr. Eponymous,"March/April 2004). Information regarding the Heimlich maneuver for drowning is readily available. One source is my chapter "Scientific Facts Show Heimlich Maneuver Best Method for Drowning Resuscitation" in the book Drowning: New Perspectives on Intervention and Prevention published under the auspices of the International Swimming Hall of Fame, by CRC Press. This chapter, which contains sixteen references, can be found on the Heimlich Institute web site, www.heimlichinstitute.org. Instead of referring readers to the scientific facts, Mr. Herzog quotes a little known freelance writer who submitted material to an Association of Amusement Parks publication. Mr. Herzog does not say whether the article was ever published. He quotes the writer as saying "Not one of the sources that Dr. Heimlich gave me panned out."

Herzog devotes two paragraphs to quotes by the president of the U.S. Lifesaving Association (USLA) who says: "What Heimlich has done is extraordinarily reckless, in the sense that he has elected to encourage lifeguards . . . to ignore the protocols they were taught and follow his recommendations. Because of his reputation, it's my opinion that many have indeed done so. . . ."

I met the USLA president several years ago when I lectured to the USLA. I recommended using the Heimlich maneuver to clear water from the lungs. This advice was at odds with the USLA president who promotes a suction device made for that purpose. Herzog would have given a more balanced account of the Maneuver for drowning if he had quoted an official report concerning the vice president of the USLA, filed a short time after he heard my presentation. The report documents that the lifesaving official saved a drowned child using the Heimlich Maneuver after CPR given by another rescuer had failed.

Herzog devotes several paragraphs to debates between myself and the American Red Cross as to whether the Heimlich maneuver should be used for drowning victims before or after CPR. Again he ignores scientific data that shows the ARC recommended CPR for drowning victims for decades. At the same time, university studies show that CPR, blowing air into the mouth, resulted in up to a 60% death rate. As reported in the Journal of the American Medical Association, July 4, 1986, the lungs fill with water in up to 90 percent of drowning victims. They literally choke to death on water, which shows the futility of blowing air into water-filled lungs.

Herzog ignores the fact that the Heimlich Institute website cites a University of Pittsburgh experimental study that proved four Heimlich Maneuvers, which takes a few seconds, clears the water from the lungs. In addition, everyone knows how to do the Heimlich Maneuver. CPR is so complicated, the American Heart Association now instructs 911 emergency phone operators they must no longer teach mouth-to-mouth to rescuers of heart attack victims. Furthermore, the AHA warns the exchange of saliva can cause major diseases.

With regard to malariotherapy,Herzog quotes two doctors of little known status who say, "It's an experimental treatment without an institutional review board (IRB)," and that [Dr. Heimlich] "experimented on citizens of a foreign country . . . in a way that would never have been permitted in this country." If Herzog had looked up FDA regulations, he would have learned that the research had been conducted in keeping with the highest standards. A letter to me from the FDA advises, "Your letter to Dr.Henney [FDA Commissioner] states that the research is conducted under the oversight of the appropriate regulatory authorities, in the People's Republic of China. That is the appropriate authority for oversight of such foreign research, not a United States based IRB."

Herzog proceeds to give another negative quote from one of the two doctors who says, "It doesn't take a rocket scientist to realize you don't give an infectious disease to somebody who is immuno-compromised."Herzog again fails to cite scientific facts that prove the fallacy of that statement. These facts are readily available on the Heimlich Institute website, which lists twenty-four references of publications by prominent scientists in leading medical journals. The studies show the efficacy and safety of malariotherapy. Malariotherapy consists of inducing a curable form of malaria into a patient, then curing the malaria in three to four weeks. Early malaria is proven to strengthen the immune system by increasing production of immune substances including interleukins and interferons, and thus has the potential for overcoming HIV infection.

One reference on the website is a historical review of malariotherapy from the Harvard School of Public Health. Syphilis of the brain, neurosyphilis, could not be cured by drugs or antibiotics due to a "blood-brain barrier". As mentioned by Herzog, Dr.Wagner- Jauregg won the Nobel Prize in Medicine for his discovery that malariotherapy cured neurosyphilis. In this country, malaria was distributed by the U.S. Public Health Service and Johns Hospital Hospital. I remember its use when I was in Cornell Medical School.Malariotheray was used throughout the world for almost fifty years, until the 1970s, when neurosyphilis was eradicated. The Harvard publication concluded: "It is not hard to imagine the almost certain fate of thousands of paretics [neurosyphilis patients] who would have sickened horribly and died but for malariatherapy."

Other references report on two studies carried out in an African hospital under the auspices of the U.S Centers for Disease Control (CDC). One study followed 112 AIDS infected children; 35 percent of those with AIDS alone died, whereas, during the same period of time, not one of the children with AIDS and malaria died. The second study of 587 children concluded: ". . . there is no adverse clinical or epidemiological association between these two important public health problems." (New England Journal of Medicine)

Herzog makes a last attempt to challenge malariotherapy by quoting a CDC 2003 statement that says: "There is no evidence that high fever therapies are effective treatment for HIV."Apparently Herzog is not aware that malaria is not a fever therapy.Malaria's effect is based on its ability to strengthen the immune system and overcome the destruction of T-cells by HIV. Fifty years ago, when little was known about the immune system, malaria's cure of neurosyphilis was thought to be caused by the fever.

Herzog charges "that the name given to the doctor's famous maneuver ignores the contribution of one of Heimlich's colleagues." Herzog bases his statement on quotes from Dr. Edward Patrick, who was a resident at Jewish Hospital in Cincinnati in 1975, where I was Director of Surgery. I met Patrick a short time before, when he came for his job interview. This meeting took place three years after I started my research and a year after the Maneuver became known to the world. In four paragraphs on the second page of his article, Herzog shows that he was aware of the time sequence. He writes that I started my research on saving choking victims in the early 1970s and published my findings in Emergency Medicine, June 1, 1974; they were immediately disseminated throughout the country by the press, and, in the Journal of the American Medical Association, the editors cited the lives saved in the first two months and named the procedure the "Heimlich Maneuver" (August 12, 1974). I subsequently published other scientific papers.

Another example of the disparity in dates that Herzog ignores is his mention of the "Patrick Energy Model to explain the pressure of the Heimlich Maneuver," which was published in Postgraduate Medicine,May 1, 1990.Herzog neglects to mention the fact that this article appeared fifteen years after the Heimlich maneuver was introduced to the world.

I want to take this opportunity to thank Cornell professors Glenn C. Altschuler, Isaac Kramnick, and R. Laurence Moore for including me in their fine book, The 100 Most Notable Cornellians, published in 2003, which is available from Cornell University Press.

Henry J. Heimlich '41, MD '43
Cincinnati, Ohio

Brad Herzog responds: Despite Dr. Heimlich's attempt to portray the article as a lone journalist's uninformed accusations, all questions about his methods were not mine but rather those of medical experts and researchers. I just reported what they said. I did not "question the value" of using the Heimlich Maneuver to save drowning victims; I explained that it remains a matter of debate in the medical community. There are "scientific facts" that support both sides, subject to selective interpretation. Regarding the malariotherapy experiments in China, I did not "accuse" Dr. Heimlich of misconduct; I related the objections of medical experts ranging from AIDS researchers to medical ethicists to the U.S. Centers for Disease Control. Dr. Heimlich says that I "ignore" a particular study performed in Africa, which he believes supports the use of malariotherapy for HIV-infected patients. In fact, I cited it in the article. However, I also noted the CDC's warnings against malariotherapy treatments, issued as recently as 2003.

As for the "full FDA approval" to which he refers, the FDA informed Dr. Heimlich that it had no jurisdiction in China. The malariotherapy study was approved by an Institutional Review Board (IRB) affiliated with the now-defunct Great Lakes College of Clinical Medicine (GLCCM), a nonprofit association of alternative medicine practitioners. After an inspection of this review board in 1999, the FDA found several violations and forbade the IRB from approving any new studies. A March 2000 FDA letter to GLCCM secretary L. Terry Chappell concluded, "We have no assurance that your IRB procedures are adequately protecting the rights and welfare of the human subjects of research."

Regarding the development of the Heimlich Maneuver and the possibility that Dr. Edward Patrick's role has been overlooked, it is simply a matter of conflicting recollections. The dates of the Maneuver's unveiling are not in dispute, but (as the story noted) the two men "differ on when they met." As Kenneth Swan, MD '60, said, Dr. Heimlich is "a controversial guy." The article was intended to offer an objective examination of some of the controversies about his work, airing contentions on both sides of the issues. I believe it did so.

Read more: "RE: LETTER OF DR. HENRY HEIMLICH," by B. Chris Brewster, President, United States Lifesaving Association

(pdf, 133Kb)

THANKS FOR A BALANCED ARTICLE on the extraordinary accomplishments and controversial assertions of Dr. Henry Heimlich '41, MD '43.Mentioned in passing but not highlighted was an achievement that caught my attention--the chronology of his education.How does one sail through a four-year graduate school in two years?

Dr. George Ubogy '58
Cos Cob, Connecticut

Ed. Note: According to Elizabeth Shepard, assistant archivist at the Weill Cornell Medical Center Archives, Henry Heimlich started medical school in the fall of 1940 under a program that admitted "seniors from scientific colleges of good standing." These students received their undergraduate degrees at the end of the first year of medical school, so Heimlich was awarded his BA in 1941. After the United States entered World War II, there was an acceleration of medical school graduations; Heimlich was admitted in the Class of 1944, but his class, due to the acceleration, graduated in December 1943.

Image Conscious
THANK YOU FOR WRITING ABOUT the Ad Hoc Committee on Improving Cornell's Image ("Extreme Makeover," Currents, March/April 2004).When we began our quest, our goals seemed simple: we wanted traditional Ivy League gear in The Store, a website and admissions material that reflected Cornell's beauty, an end to the "Big Red Box" logo, and improvement in Cornell's standing in the U.S. News & World Report rankings.We had no idea that our research into the ills of Cornell's marketing would result in even deeper questions about the future of Cornell.

Further analysis led to an investigation of class size, where we found that Cornell ranked 125th out of America's top 125 national research universities in its percentage of classes with fewer than fifty students and 72nd in its percentage of classes with fewer than twenty students. This not only deprives Cornell of the ranking it deserves but affects student performance, satisfaction, and retention.Worse, these effects are magnified among underrepresented minorities, lower income students, and those without AP credits (see www.cornellimage.org/).

After your article was published, we discovered that many alumni were as concerned about these issues as our fellow students. Each day, I receive e-mail from alumni hailing our work and asking us to take it in new directions ranging from better recruitment videos to no-loan financial aid packages such as those offered by Harvard and UNC.We also hear horror stories about poor customer service, unresponsive administrators, and abysmal alumni involvement--yet at the core of each story is a love for Cornell.We are in the process of categorizing these responses and will present them to the administration at the end of this academic year. I know that President Lehman cares as much about Cornell as we do--he is, after all, a Cornellian.

I look forward to continuing this dialogue through the formation of a student/alumni task force. Together, we can build a better Cornell.

Peter Cohl '05
<peter.cohl@cornell.edu>
Chair, Image Committee
Ithaca, New York

Objecting to Clinton
IT WAS WITH INCREDULOUS AMAZEMENT that I learned of the University's decision to invite Bill Clinton to the 2004 Convocation (see From the Hill, page 24). I have disagreed with Cornell's recent philosophy regarding some issues, but am stunned at the decision to invite this flawed, amoral, corrupt person as the Convocation speaker. Inviting Mr. Clinton to speak as a lecturer is one thing; inviting this impeached ex-president to speak at Convocation is quite another. I recognize that the choice was made by the senior class, but I also recognize that Cornell's president heartily approved this choice.

I support the efforts of universities to expose students to a variety of thinkers, doers, and visionaries. I consider it the duty of all citizens to listen, think about, and judge the actions of their leaders. I have long done so regarding Mr. Clinton. As a result of this study, I choose to sever all ties to the University rather than appear to support Mr. Clinton. I cannot think of supporting the university of Ezra Cornell when Mr. Clinton is honored by such an invitation, and I urge all alumni who feel the impropriety, as I do, of this invitation to join me in expressing their outrage by withholding contributions and expressing their written dissatisfaction.

Jen Gage Sage '83
Etna, New York

Objecting to Milstein
I AM WRITING TO PROTEST THE DESIGN of the new Architecture school building,Milstein Hall (From the Hill, November/December 2003). The first design for this building was fiercely opposed by the AAP alumni, and it was widely seen as arrogant, inappropriate, and disrespectful of the context (not to mention huge and ugly). It is astonishing that the second design-selection process could have produced another poor design.

While Stephen Holl's design provoked anger and disgust, Barkow Leibinger's seems poised to elicit disappointment and resigned cynicism. The form of the building appears to be largely a deferential reaction to the site, but it neither honestly embraces Sibley nor stands respectfully apart. Instead it sidles uncomfortably and indecisively close, resembling a glorified but haphazard collection of temporary pre-manufactured buildings--the kind elementary schools plunk down in their parking lots for overflow classroom space. As Cornell architects, we were taught to aim for Great Architecture--the harmonious melding of function and art. Where is the beauty? Where is the vision? Where is the inspiration?

While many may argue that this design has a variety of merits (and it probably does), anyone who calls this Great Architecture has set the bar too low. Let's scrap this design and have another competition--and this time, let's open it up to everyone and let the faculty, students, and alumni vote.

Scott Rodwin '90, BArch '91
Boulder, Colorado

THE PROPOSED DESIGN FOR MILSTEIN Hall is very disappointing. The students of the Architecture school, present and future, deserve a much more serious building. An enlightened, inclusive, and historically aware design would create a complex that would physically connect Sibley and Rand halls, provide a new entrance with a forecourt, and exemplify the history of the college's expansion.

The Barkow Liebinger design does none of these things. And it takes for granted the demolition of Rand Hall, built ninety years ago as a memorial to several Rand family members, including Jasper Rand Jr. 1897. The fact that the University administration wants to replace it with such a bland and simplistic structure says volumes about its respect (or lack thereof) for Cornell's history.What an unfortunate example for students who are expected to go out into the world and make it a better,more enlightened place.

Peter Szilagyi '70, BArch '72
Littleton, Colorado

Ed. Note: According to Hal Craft '60, PhD '70, vice president for administration, a second concept for Milstein Hall is being considered, one that would "draw the building more to the west (away from the corner with East Avenue) and connect it more solidly with Sibley." Craft also notes that the model shown in the magazine was "just at the schematic design stage, so moderate changes in the design may still occur if we continue with that concept."

Clueless at Cornell
I AM AMAZED BY THE UTTER CLUELESSNESS of the University with regard to mental health issues ("Crushed by Cornell," Letter from Ithaca, January/February 2004). I think that the reason mental health admissions are up from ten years ago is that people now recognize when someone is depressed and try to get help for that person. If I had a buck for each time I heard a story when I was at Cornell about someone being on "suicide watch" for a friend, or talking to someone who was dropping out due to stress, or-- worse--hearing about the latest bridge casualty, I might be able to take another class or two up there. And I resent the unnamed academic advisor saying that more people are coming to school with mental and physical health problems. That insinuates that the University has nothing to do with students'mental health problems, which is an outright falsehood. I know. I wasn't mentally ill when I started at Cornell, but I was when I left. Is that the value of a Cornell education?

Jeff Leinbach '96
Allentown, Pennsylvania

Open Doors, Open Hearts,
Closed Minds?
THE OVERWHELMING DOMINANCE of the political left on most of today's college and university faculties is beyond dispute.Many disciplines routinely deal with issues that are inherently controversial; how are students to gain an appreciation for various sides of these debates when they enroll in courses taught by people increasingly committed to one side?

As a professor for thirty years, I have observed the steady leftward march of academia, a trend that affects not only courses and their content, but hiring, tenure, and promotion. If Cornell wants to regain an open-minded character, it is possible to work toward true intellectual diversity. But we first need to admit there is a problem.

A. Louis Shor '44, BS '47, DVM '53, writes: "Could it be that faculty members have had the time and interest to listen to all sides of political questions and, in their wisdom, lean toward the liberal side?" (Correspondence,March/April 2004). The stunning arrogance of this opinion aside, consider the fact that the current political imbalance does, in fact, convey exactly that message to students. No debate, no problem. How tragic, in a setting committed to "diversity."

John Macionis '70
Kenyon College
Gambier, Ohio

Musical Oversight
YOUR ARTICLE ABOUT THE MUSIC department did not mention the ensemble that shaped many hours of my time at Cornell ("Theme & Variations," January/February 2004).When I auditioned for the Cornell University Lab Ensembles in the fall of 1991, I was the only freshman and only woman in the saxophone section of one of the big bands. Through Professor Karlton Hester's mentorship, I learned about community, cooperation, and the music that, as Jaki Byard said, "some call jazz." The eight semesters I enrolled in the Lab Ensembles reflected my most consistent academic interest. But throughout that time, we struggled to have the jazz ensembles recognized by the music department--and the article's lack of reference to the C.U.L.E. shows this struggle is ongoing.

Joanne Seiff '95
Bowling Green, Kentucky

Grammar Gaffe (Again)
WILLIAM BROWNLEE '50 EXPLAINS what he calls his "minor quibble" about the phrase "never repeated the same lecture twice" by saying, "the older I get, the more cantankerous I get" (Correspondence, January/February 2004). Brownlee's letter contains its own gaffe, however, as "minor quibble" is redundant. The older I get, the more rigorous intellectually I try to get. Thirty-five years from now, perhaps I will have the good fortune of reaching the present level of rigor of my mother, who is ninety-one.

Felicia Nimue Ackerman '68
Providence, Rhode Island

Correction
Robert Shapiro '04 points out that "Theme & Variations" by Robert Doerschuk incorrectly refers to Neal Zaslaw as chair of the Department of Music (January/February 2004). The current chair is Rebecca Harris-Warrick.

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