Heimlich's Maneuver

In the end, Heimlich still earned a partial victory. His maneuver was listed in the American Red Cross's protocol, which meant that lifeguards would be ready to use it after CPR. Patrick's Lima case is cited as evidence.

Ornato attached another qualifier, noting that the effect of the Heimlich maneuver had not been properly studied, and until it was, it ought to be used sparingly. Ornato refused to comment for this story, saying that he was leery of further rancor with Heimlich.

But upon leaving the conference, Modell was determined to resolve the debate objectively. He and a colleague, Dr. Richard Melker, received funding to study the maneuver on dogs.

"Dr. Heimlich called me and volunteered to help me," recalls Modell. But that collegial attitude didn't last. Before Modell's study began, Heimlich held a press conference. He held a cocker spaniel for television cameras, dunking its head into an aquarium to demonstrate the cruelty of Modell's study. Heimlich condemned the drowning of dogs to prove what was, to him, self-evident: that the Heimlich maneuver worked.

He also notified People for the Ethical Treatment of Animals and sent a letter to the University of Florida newspaper. The effect was a campus seething with protesters, the most avid of whom called in bomb threats to Modell's lab and death threats to his home. It remains a chilling memory for the doctor. "I don't want to get into the details of that," he says. "I don't want to start another war." Modell dropped the study.

In a match between the two schools of science, Heimlich brought an extra weapon -- politics, the emotional kind. "The reason that we were willing to do it in the first place was to pacify Dr. Heimlich," says Modell. "And then he prevented it from happening."

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Heimlich won the skirmish with Modell, but he was fighting wars on multiple fronts -- one of them in Cleveland, where Orlowski dealt a crushing blow to Heimlich's promotional campaign.

In a study published in the Journal of the American Medical Association, Orlowski reported on a 10-year-old boy who was submerged for between one and two minutes. It should have been a "routine resuscitation," Orlowski wrote, except that the lifeguard gave the child the Heimlich maneuver first.

The boy vomited so much that it was hard for the lifeguard and a physician to perform CPR. Some of the vomit made its way to his lungs.

Orlowski wrote that, given all the variables, CPR would have given the boy a 90 percent chance of recovery. Instead, he slipped into a coma and died in a nursing home seven years later.

Again, Heimlich retaliated, authoring a letter that the journal's editors deemed unfit for publication. Orlowski saw it. "He called me a liar and said I was totally unscientific and didn't understand how important his maneuver was."

Orlowski has tracked cases in which the Heimlich maneuver was used. His data shows that it was destructive in the rescues of more than 30 victims. But even with overwhelming evidence on his side, Orlowski admits the difficulty of battling Heimlich's star power. "That's what he's been bargaining on for years," says Orlowski. Even if scientists recognize the dangers, Heimlich remains persuasive to lay persons. "We still see cases where parents and well-meaning individuals perform the Heimlich maneuver," says Orlowski. "The child immediately vomits, and that creates all kinds of problems."

Orlowski calls Heimlich an "obstructionist" who chooses self-interest over ethics. "His approach has been to prevent the studies from ever being done, so nobody can get an answer to whether he's right or wrong."

Having followed the debate himself, Peter Heimlich sides with detractors. "This isn't theoretical," he says. "These are life-and-death issues . . . I don't think it's asking too much for him to substantiate his own case reports, instead of attacking anyone who dares to ask any questions."

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By the early '90s, Drs. Heimlich and Patrick had become notorious among drowning experts. But Heimlich's lobbying efforts -- inside the medical community and with the popular press -- had begun to pay dividends.

In 1993, they were invited to give a presentation to the Institute of Medicine, the governing body of American health care. They bombed.

Dr. Linda Quan, who made a presentation to the same committee, remembers the looks on the faces of oncologists who heard Heimlich and Patrick describe the impossibility of ventilating through fluid, a feat doctors accomplished with newborn babies every day. Quan chuckles at the memory of Heimlich and Patrick's desperate attempts to win over the nation's sharpest medical minds by illustrating their theory with cartoons that violated elementary science.

Even stranger, reports from that meeting indicate that Heimlich and Patrick changed the two-year-old drowning victim in Lima from a girl to a boy.

"The Institute of Medicine is the crown jewel of medical intelligentsia in the United States," says Admiral Steinman. "They looked at this issue and said, 'Bad idea.'"

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Though his science failed to impress, Heimlich's name still worked, and he had a winning way with reporters.