Politics

The Choke Artist

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"A serious matter has been brought to my attention," the letter began. Addressed to an official in the Office for the Protection of Research Subjects at the University of California at Los Angeles, it accused two UCLA medical researchers of participating in illegal human experiments on HIV patients in China. "These experiments consist of giving malaria to people already suffering from HIV and full-blown AIDS," the letter alleged, before going on to make an even more startling claim: "[T]hese experiments have been conducted under the direction of Dr. Henry J. Heimlich, known for the Heimlich maneuver."

The letter, which was sent via e-mail in October 2002 and was from a "Dr. Bob Smith," was merely the first in a series of epistolary attacks against Heimlich. A few months later, editors at more than 40 publicationsranging from The New York Times to the medical journal Chestreceived missives from someone calling himself "David Ionescu" that accused Heimlich of improperly taking credit for inventing a type of esophageal surgery. And then, in September 2003, the website heimlichinstitute.com went online. Its URL was almost identical to the official website of Henry Heimlich's Heimlich Institute, heimlichinstitute.org, but, rather than being dedicated to burnishing the doctor's legend, it was devoted to tearing it down. The site featured a long, angry indictment of Heimlich and accused him of all sorts of medical misconduct. The site's proprietor was listed as "Holly Martins"the protagonist in the 1949 film noir The Third Man.

The octogenarian Heimlich seemed an unlikely target of so many people's ire. He had entered into the pantheon of medical history not for inventing a disease-eradicating vaccine or for isolating the DNA of a killer virus but, rather, for developing an anti-choking maneuver that even a child could perform. And, yet, it is the very simplicity of Heimlich's lifesaving technique that makes it so ingenious; because anyone can perform the maneuver, anyone can save a life. Since its invention in 1974, it has become a standard First Aid procedure around the world; and, while it may have been hyperbole for Norman Vincent Peale to once declare that Heimlich "has saved the lives of more human beings than any other person living today," it was fair to say that, by the measure of name recognition at least, the maneuver had made Heimlich America's most famous doctor.

But, after the letters started arriving, Heimlich could no longer rest on such laurels. When I met him in his office at the Heimlich Institute, he was under siege. Heimlich is tall and thin with a sharp nose and watchful gray eyes, giving him an almost avian appearance. He wore a coat and tie and, as he sat at his desk, he told me that he still put in a five-day work weekbut what he was working on was unclear. The impressive-sounding Heimlich Institute, in fact, consisted of just two rooms in an administrative annex behind Cincinnati's Deaconess Hospital. On the afternoon I visited, Heimlich had cajoled his old secretary, who had recently been laid off due to lack of funds, to come in to help find some files for me; otherwise, he was the only person at the Institute.

And, yet, even in its diminished state, Heimlich's office served as an impressive testament to his unique stature. Framed cartoon strips that referenced the Heimlich maneuver shared wall space with pictures of celebritiesCher, Elizabeth Taylor, Ronald Reaganwho were saved by his anti-choking treatment. A giant toy caterpillar"Heimlich," a ravenous character from the Pixar movie A Bug's Lifesat on the floor by his desk. Heimlich thumbed through a stack of newspaper articles. "I still get clippings from papers from all over the country whenever somebody saves a life," he said in a tone that sounded both boastful and surprised.

Heimlich was copied on some of the letters attacking his reputation; but, initially, he paid them little mind, assuming no one would take the allegations seriously. Soon, though, the attacks began to exact a toll. UCLA launched an investigation into its researchers' work with Heimlich and ultimately found that one researcher had violated federal laws. Meanwhile, The Cincinnati Enquirer, Heimlich's hometown paper, ran a front-page story in which a rival doctor called Heimlich "a liar and a thief." Other doctors soon followed suit. Even the American Red Cross began to take a second look at the Heimlich maneuver. Heimlich and his family were traumatized. "It's an incredibly painful and difficult thing for someone to go through in the twilight of his life," Phil Heimlich, the eldest of the doctor's four children, told me.

Heimlich eventually decided that he could no longer do nothing. He hired a lawyer and an investigator to determine who was behind the allegationsor, as Heimlich called them, "the hate campaign." It was an investigation that would take months and frequently run into dead ends. For a reason that Heimlich did not yet understanda reason so shocking that, when he did discover it, it would shake him to his corehis mysterious critics had gone to great lengths to conceal their identities, wielding their anonymity as a potent weapon against his fame.

But, although he was pained by the attacks, in some ways Heimlich actually relished the confrontationbecause he had never shied away from a fight. Lost amidst the tchotchkes and celebrity photos in his office that testify to the maneuver's success is the story of just how hard he fought to get the medical establishment to accept it in the first place. Indeed, Heimlich's achievement was not so much the maneuver itself but the vigorous and sometimes underhanded campaign he waged to promote it. Heimlich's geniusone that has been adopted lately by everyone from drug companies to war plannerswas to circumvent the experts and take his case directly to the people. A showman as much as a scientist, a brawler as much as a doctor, Heimlich was the P.T. Barnum of medicinehis career serving as testament to the fact that even the supposedly fact-based medical realm is susceptible to the phantom powers of personality and salesmanship.

"This letter is to bring to your attention allegations that the International Society of Surgery, the World Journal of Surgery, and the American medical journal, Diseases of the Chest, have been defrauded by Dr. Henry J. Heimlich of Cincinnati, Ohio, USA, best known for the Heimlich maneuver,"letter from "David Ionescu," April 3, 2003.

 

In 1963, a Florida coroner named Robert Haugen published an article in the Journal of the American Medical Association that called attention to a frequently overlooked medical problem. Haugen detailed the cases of nine Florida diners who each collapsed and died while eating at a restaurant. Their deaths were initially attributed to natural causes, usually a heart attack. As Haugen wrote, it wasn't until his office performed an autopsy and discovered a large bolus of food lodged in each person's airway"steak in four cases, beef in two, ham fat in one, kippered herring in one, and broiled lobster in another"that the cause of death was correctly determined to be asphyxiation. Haugen dubbed this phenomenon "the cafe coronary" and implored the medical community to recognize choking as a serious problem.

Medical researchers began working to come up with an anti-choking treatment more scientifically advanced than the age-old backslap. One doctor invented the "Throat-E-Vac," which, after being inserted into the victim's mouth and creating an airtight seal, supposedly sucked up whatever was obstructing the airway. Haugen himself marketed a nine-inch-long pair of plastic tweezersthe "ChokeSaver"that would-be rescuers could use to grasp the offending piece of food in the victim's throat and pull it out. As the public furor over choking grewwith radio stations running public service announcements about the threat posed by "the cafe coronary"it was clear that the doctor who devised a successful anti-choking treatment would be hailed as a medical hero.

That Henry Heimlich found such a prospect appealing was hardly surprising. He had experienced his first taste of the glory that comes to those who save lives in 1941, when, as a 21-year-old passenger on a New York City-bound train, he rescued a fellow traveler after the train derailed in Connecticutearning him a mention on the front page of The New York Times and a gold watch from the Greater New York Safety Council. After serving as a Navy doctor in World War II, during which he volunteered for "prolonged extra-hazardous" duty in the Gobi Desert, he returned to New York and specialized in thoracic surgerya field that allowed him to hold a patient's beating heart in his hands. But even that proved unsatisfying. As a mere surgeon, Heimlich concluded, he was limited to the finite number of people on whom he could operate. By devising new and revolutionary treatments and procedures, he could exponentially increase the number of lives he saved.

Heimlich started off, in the mid-'50s, by introducing a surgery that made it possible for people with severe esophageal damage to swallow food. He called it the "Heimlich operation." Later, he devised a chest drain valve that could be used to treat a collapsed lung, which he named the "Heimlich valve." In 1969, Heimlich, along with his wife Jane (daughter of the dance hall impresario Arthur Murray), his sons, Phil and Peter, and his twin daughters, Janet and Elisabeth, moved to Cincinnati, where he became director of surgery at the city's Jewish Hospital. It was there that he turned his attention to choking.

Heimlich still relishes telling the story of his most famous invention. "No one was doing much about [choking] except for these gadgets," he says, dismissively waving his hand. He set out to develop a treatment that was, as he puts it, "so simple anybody could do it." From his thoracic surgery experience, Heimlich knew that at the moment of choking the lungs contained a substantial amount of air. He concluded that the best hope for devising a practical anti-choking treatment lay in harnessing that air to expel whatever was lodged in the larynx.

Heimlich's research methods, at least with the benefit of 30 years of hindsight, seem comical. In his hospital's animal lab, he partially anesthetized a 38-pound beagle"the equivalent of having three or four good stiff drinks at dinner," he told his lab technician. Next, he "strangled" it with a cuffed endotracheal tube inserted into the larynx. Then Heimlich attempted to dislodge the tube. At first, he tried pressing on the dog's chest, but nothing happened; with the beagle on the verge of death, he dejectedly removed the tube. Then inspiration struck. "I just got the idea that if I push up on the diaphragm, the diaphragm comes up, the chest cavity decreases in volume, and that would compress the lungs," Heimlich recalls. Sure enough, when he did just that, the tube flew out. He tried the same technique on three other beagles, each time with the same result. Elated, he sent his lab tech down to the hospital commissary for some raw hamburger. That flew out of the beagles' mouths, too.

Of course, all Heimlich had proved with his experiments was that his anti-choking treatment worked on dogs. Whether it would work on humans was an open question. Seeking an answer, Heimlich prevailed upon the editor of Emergency Medicinea "throwaway" journal that did not require its articles to be peer-reviewedto let him propose his anti-choking treatment in its pages. Writing in the June 1974 issue, under the headline "Pop Goes The Cafe Coronary," Heimlich instructed would-be rescuers on how to perform the maneuver. He urged readers to report the results of their rescue attempts to him. The public would serve as both his researchers and his subjects.

Heimlich made certain that a copy of his Emergency Medicine article made it to Arthur Snider, the Chicago Daily News's nationally syndicated science writer. The week after Snider's article on Heimlich's proposed new anti-choking treatment appeared, a retired restaurant owner in Washington state used the new treatment to save his choking next-door neighbor. "News Article Helps Prevent A Choking Death" read the headline in The Seattle Times a few days later. Other Snider readers across the country made similar rescues, inspiring more headlines. But, despite the growing number of positive anecdotal reports, not everyone jumped on the Heimlich maneuver bandwagon. Based on the lack of hard scientific evidence, the American Red Crossmuch to Heimlich's consternationwould only endorse the Heimlich maneuver as a secondary technique to be used if back blows were unsuccessful.

The only body that seemed capable of resolving the dispute between Heimlich and the Red Cross was the National Academy of Sciences. In June 1976, the academy's Committee on Emergency Medical Services convened a two-day conference on "Emergency Airway Management." The committee included such preeminent research doctors as Peter Safar, the co-inventor of mouth-to-mouth resuscitation, and James Jude, who discovered cardiopulmonary resuscitation (CPR). On the conference's first day, Heimlich gave an impassioned speech, boasting of the more than 500 lives he said the maneuver had already saved. After his presentation, nine conference participants gathered in the academy's boardroom to try to reach an official consensus on choking treatments. For hours, they debated. Finally, as the clock ticked past midnight, they voted six to three in favor of elevating the Heimlich maneuver above the backslap.

But the group's chairman, an anesthesiologist named Don Benson, still harbored doubts, and, the next morning, he told the conference that the group had been unable to obtain a "universal opinion." Heimlich stormed out of the conference. He was convinced he had a proven lifesaving idea and that the only thing preventing the medical establishment from accepting it was professional jealousy. "These were the guys who were the experts ... but none of them, despite all their years of expertise, had come up with this idea," Heimlich says with bitterness that, three decades on, still seems fresh. "And then here comes this unknown guy in this field that they've been working their whole lives in, and not only does he discover this thing, but it's named after him."

From this point on, Heimlich decided to bypass the medical establishment and to take his maneuver directly to the public. He sold Heimlich maneuver posters and t-shirts (through a company he started with his son Phil) and made a slick film that featured choking actors being saved by his technique and a horror-movie-like score composed by his other son, Peter, a musician who performed in a band called "Choke." He barnstormed across the country, appearing on "The Tonight Show" and speaking to non-medical groups about the maneuver. In his dark suits and conservative ties, Heimlich looked the part of a somber doctor. But his presentations were anything but dull. He told stories of miraculous rescues and cracked risque jokes while watching Johnny Carson demonstrate the maneuver on Angie Dickinson; his speeches often ended with a massive group hug as he asked everyone in the audience to practice the maneuver on the person sitting next to them. By the late '70s, a booking agency ranked Heimlich as one of the top ten public speakers in the United States. "The guy was a dynamo," says Trevor Hughes, an anesthesiologist who became an outspoken advocate of the maneuver. "It was like when you see a tornado cutting across the plains or you come up against a force of nature. ... His charisma was incredible."

Eventually, the Red Cross and the rest of the medical establishment seemed to realize it was fighting a losing battle. Although Heimlich still lacked much in the way of convincing laboratory studies, he had managed to create a set of facts on the ground. In 1985, Surgeon General C. Everett Koop proclaimed the Heimlich maneuver "the only method" that should be used to treat choking victims. The next year, when the American Heart Association, in conjunction with the Red Cross, published its "Standards and Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care," it recommended the maneuver as the primary anti-choking treatment.

Heimlich had wonmaking himself a household name in the processbut he had also created a number of enemies. Thanks to Heimlich's constant criticism of the organization, enrollment in the Red Cross's first-aid classes dropped, and the organization had its lawyers explore the possibility of suing him for slander. The National Academy of Sciences also suffered indignities: Heimlich had declared backslaps "death blows" and accused the organization of engaging in a cover-upa "medical Watergate," he called it. There were also the individual doctors with whom Heimlich had tangledhe even tried to initiate ethics proceedings against one doctor who opposed the maneuver.

Thirty years later, Heimlich knew that the campaign against him could have been the work of these old enemies. He told me he drew comfort from the words of the Belgian poet Maurice Maeterlinck, who wrote, "At every crossway on the road that leads to the future, each progressive spirit is opposed by a thousand men assigned to guard the past." He thought about the manyif not necessarily 1,000men who had opposed him, and he tried to determine who would engage in such attacks today. He came up with a short list, which he conveyed to his lawyer, who in turn passed it on to the investigator. But the investigator soon determined that none of the suspects were involved. Still, there was some progress. Although Heimlich's tormentors had signed their attacks with fake names, employed multiple e-mail accounts and Web-hosting services from far-flung places (such as the Czech Republic), and used phone numbers that were registered under even more pseudonyms, the investigator made the startling discovery that the attacks could be traced back to the same ISP number. In other words, Dr. Bob Smith, David Ionescu, and Holly Martins were likely the same person. But if that person wasn't one of Heimlich's suspects, then who could it be?

"Even after being made aware of potentially life-threatening risks associated with the Heimlich maneuver for drowning, did [Heimlich and a colleague] continue to encourage the public to test it on one another, putting at risk not only the victims but their rescuers? ... Was the Heimlich maneuver for drowning rescue nothing more than a scam?"from "Conclusion," by "Holly Martins," heimlichinstitute.com.

 

Heimlich had based his antichoking maneuver on little science but much intuition. And, because his intuition had proved correct, his populist campaign on the maneuver's behalf appeared heroic. It was the act of an innovativeif maverickdoctor who wanted to save lives right away instead of waiting for the medical establishment to catch up and give his idea its seal of approval. In many ways, Heimlich's storydespite its rough edgeswas inspirational. But that inspiration had a downside. What if Heimlich viewed his experience with the maneuver as a sign that he was uniquely equipped, perhaps even destined, to solve other, even more pressing medical problems? And what if Heimlich, convinced of his own rightness, started up his publicity machine in order to sell the public another medical treatment, but, this time, his intuition turned out to be incorrect?

In the early '80s, Heimlich, searching for an even grander lifesaving idea, became convinced there was another, wider-reaching use for his maneuver. In 1974, a surgeon named Victor Esch claimed he used Heimlich's anti-choking treatment to save the life of a man who had nearly drowned on a Delaware beach. "[W]ater gushed out of his mouth and he began breathing," Esch reported. In subsequent years, Heimlich received a handful of similar reports, and, in 1985, he argued that the maneuver should replace CPR at a joint American Heart Association-Red Cross meeting in Dallas, Texas.

As had been true nine years earlier at the National Academy of Sciences, Heimlich lacked any convincing scientific studies to support his claim, and he had even fewer anecdotal reports. There was also concern among drowning experts that the Heimlich maneuver was potentially dangerous, since it would delay resuscitation efforts and was likely to induce vomiting, which can lead to aspiration pneumonia. And yet, the four other members of the drowning panel agreed to add the maneuver to the drowning rescue protocols as a secondary treatment. Heimlich's public fight over choking seemed to play a role in their decision. "We were aware that there was controversy over the prior set of guidelines on choking," says Joe Ornato, the drowning panel's chairman and an emergency medicine doctor at the Medical College of Virginia. "I didn't want anyone to potentially not have his life saved if it turned out Dr. Heimlich's idea was correct."

But Heimlich was not mollified. He continued to agitate for the maneuver to replace CPR as the primary near-drowning treatment, and, eventually, the Institute of Medicine (IOM)the nation's leading medical advisory groupagreed to give him a hearing. In 1993, Heimlich testified before an IOM committee. "[Heimlich] kind of impressed me as a guy who doesn't really know anything about research science," says Peter Rosen, who chaired the IOM committee and was then an emergency medicine doctor at the University of California at San Diego. "It was an old man telling tales." The IOM committee's subsequent report concluded that there was no good evidence to support the routine use of the Heimlich maneuver on drowning victims.

Just as he had done during his fight over choking, Heimlich decided to circumvent the medical establishment. In 1995, he appeared at a U.S. Lifesaving Association seminar and urged the assembled lifeguards to ignore the American Heart Association guidelines as an act of conscience, adding, "I think the Nuremberg trials told the story that no one can be excused for saying, 'I was ordered to do so or was taught to do so, to kill people.'" That same year, Jeff Ellis & Associates, the nation's largest private lifeguard companywhich staffs many of the nation's major water parks and trains about 35,000 lifeguards annuallybegan teaching the maneuver as a first response. It continued to do so for the next five years, until a reporter for the water park industry trade magazine Fun World wrote a story documenting the questionable science behind Heimlich's crusade.

There is much speculation in the lifesaving community that Ellis's five-year embrace of the Heimlich maneuver compromised safety at the company's facilities, and there are rumors of rescues that went awry. An Ellis spokesperson refused to answer any questions about the company's experience with the maneuver. But James Orlowski, a pediatrician in Tampa, Florida, who has tracked the use of the Heimlich maneuver in drownings, says he knows of more than 30 cases (though not at Ellis pools) in which the use of the maneuver had "destructive" resultsfrom stomach rupture to aspiration pneumonia to death. Orlowski says he knows of no instances where the maneuver saved a near-drowning victim.

Ellis's decision to drop the maneuver from its protocol was a severe blow to Heimlich. But he turned to his supporters for solacenone more so than his family. Although Heimlich still had many admirers among the general public, their regard for him could never approach the larger-than-life status in which his family held him. His eldest son Phil, who went from selling Heimlich maneuver t-shirts to a successful legal career to an eventual seat on the Cincinnati city council, credits his father for his decision to go into politics. "He really inspired me, because he used his abilities to have a real impact on society," he says. When Phil had his own son, he named him Henry. And, while Phil worked on the public stage to carry on his father's good name, Heimlich's younger son Peter toiled privately. Having left Cincinnati to live in San Francisco and then Portland, Oregon, Peter typically only saw his father when the doctor visited the West Coasttagging along with him to "The Tonight Show." But Peterwho eventually put aside his musical ambitions to start a business with his wife importing fabrics from Asiastayed close to his father in another way. For years, Henry would send Peter newspaper clips and medical journal articles about his latest accomplishments, and Peter would dutifully save every oneuntil he had assembled what may be the world's largest private archive devoted to the life and times of Henry Heimlich.

"[I]njecting malaria into people already sick with another disease, meanwhile denying them access to other aids treatments, is reminiscent of the Tuskegee syphilis research atrocities. Yet, according to Heimlich, Chen, et al., denying other treatments to their Chinese research subjects was a condition of participation in their study."letter from "Dr. Bob Smith," October 2, 2002.

 

"I want to truly teach you about malariatherapy," Heimlich said one day in the office at his condominium, as he motioned for me to move my chair closer to his. He had pulled several large black binders from his bookcase and had one of them sitting open across his lap. "Malariatherapy, I'll tell you, is very important. ... I think there's nothing more important that we can talk about."

Of all the battles Heimlich has waged, none has proven as controversial as malariatherapythe practice of intentionally infecting a patient with malaria in order to treat another ailment. And yet, perhaps because of its controversial natureto say nothing of its grandiositymalariatherapy is the medical crusade most dear to him. Like all of Heimlich's endeavors, malariatherapy does have one foot in the realm of legitimate science. In 1917, the Austrian psychiatrist Julius Wagner von Jauregg proved that a malaria-induced fever would kill the syphilis micro-organism after testing the theory on patients. Malariatherapy soon became the standard treatment for neurosyphilis, and, in 1927, Wagner von Jauregg was awarded the Nobel Prize in medicine for his work. The discovery of penicillin in the 1940s, however, rendered malariatherapy obsolete, and it was eventually abandoned as a medical treatment. But, in the mid-'80s, Heimlich started campaigning to resurrect the practicenot as a treatment for neurosyphilis but as a means to fight other, more intractable, diseases.

His first target was cancer. Although he had no expertise in oncology, Heimlich's idea of treating cancer with malariatherapy was not immediately dismissed. The Centers for Disease Control (CDC) even invited him to Atlanta to discuss it. But the CDC was ultimately unwilling to supply Heimlich with malariainfected blood, so he took his work across the border. In 1987, he persuaded doctors at the Mexican National Cancer Institute in Mexico City to begin treating five patients with malariatherapy. The results were not promising: Less than a year after their first inoculations, four of the patients had died.

But Heimlich was not so easily discouraged. If malariatherapy didn't work on cancer, he believed there were other afflictions that it might cure. In 1990, he published a letter in The New England Journal of Medicine suggesting malariatherapy as a treatment for Lyme disease. It wasn't long before "Lymeys" from as far away as Hungary were requesting the treatment from Heimlich. But, when a New Jersey woman who was one of his first Lyme patients later denounced Heimlich"[I]f anybody ever asked me about Dr. Heimlich and his supposed cure," she said, "I wouldn't hesitate to tell them to run away fast"the tightly knit Lyme community turned against malariatherapy.

Nothing, however, could shake Heimlich's faith. In fact, each time malariatherapy failed, his ambitions for it seemed to growso much so that, by the early '90s, he was touting it as a solution to arguably the world's most pressing medical problem: AIDS. Eminent immunology experts, such as the director of the National Institute for Allergy and Infectious Diseases, Anthony Fauci, dismissed Heimlich's idea as "quite dangerous and scientifically unsound." But Heimlich did not need their support. All he needed was money and a place to try out his idea. In Hollywood he found the former; and in China he found the latter. Using private donations from prominent members of the entertainment industryincluding Amy Irving and Estelle GettyHeimlich established a malariatherapy clinic for HIV patients in Guangzhao, China. There, beginning in 1994, a team of four Chinese doctors injected at least eight HIV patients with malarial blood; for each patient, the Heimlich Institute provided the doctors between $5,000 and $10,000 in funding.

In 1996, Heimlich went to the eleventh International Conference on AIDS in Vancouver and made a stunning announcement. He reported that the CD4 countswhich are depleted as HIV progresses to AIDSin two of the Chinese HIV patients had increased after a course of malariatherapy and that the counts remained high two years later. Before the Vancouver conference, he had stopped in Portland to visit Peter, to whom he had touted his China study. "This will put us over," he told his son. But, when AIDS experts looked closely at Heimlich's results, they saw that the test the Chinese doctors had employed to measure CD4 levels was notoriously unreliablerendering the data useless. After a falling out with the Chinese doctors, Heimlich began searching for other countries where he could do a clinical trial, but no one was interested.

Two years ago, Heimlich changed the name of malariatherapy. "People hear malaria and they shy away," he explained to me, "so we'll call it immunotherapy." Heimlich was seated in a large recliner, and, since he was working from home that day, he wore a plaid shirt and an old pair of blue bedroom slippers. For more than an hour, he flipped through the binders and read me portions of various medical studies that he said proved malariatherapyas he still frequently called itworks. "So we're not without evidence," he said. But, when I later read the studies in their entirety, they showed no such thing; Heimlich was cherry-picking the passages that seemed to support his position. His method reminded me of something Peter Rosen, the emergency medicine doctor who clashed with him over drowning, had told me. "One of the differences between people who do science and people who don't is the people who do science realize that what you're trying to do in science is falsify a hypothesis," Rosen said. "And only after you examine all sorts of evidence and you can't falsify a hypothesis do you establish that the hypothesis is true. The people trying to prove a hypothesis look at any piece of positive evidence and then stop. Heimlich never understood that distinction."

As Heimlich droned on, he seemed more pathetic than dangerousjust an old man telling tales, one whose crackpot theories would, thankfully, never gain currency or be put into practice again. But then Heimlich opened his last binder, which was marked confidential, and pulled out two sheets of paper. "Now I will tell you about the malariatherapy, or immunotherapy as we now call it, in Africa." He began to read from one of the sheets. "The Heimlich Institute has been collecting CD4 and viral load data on patients who are HIV-positive and have become infected with malaria. This data will provide support for the concept of using malariatherapy for treating HIV infection." The study involved the questionable practice of initially withholding treatment for malaria, so Heimlich would not tell me where in Africa this new malariatherapy trial was being done. "You never know how the politicians will react in these countries," he explained. But, according to a public health physician who has worked on AIDS in East Africa and has knowledge of Heimlich's latest project, the study site is in Ethiopia. An official with the Ethiopian Ministry of Health told me that the ministry is unaware of any malariatherapy work being conducted in the country and that, if it is, it is being done without proper notification and permission.

Still reading from the papers, Heimlich boasted about the study's early results. Six of the first seven HIV patients treated with malariatherapy, he claimed, had experienced decreases in their viral loads. Now he was eagerly anticipating results from the 42 other patients in the study. He seemed to have little doubt about what those results would be. "I've been right in just about everything I've done," Heimlich said. "And when it gets to something like this, I know."

"Evidence does exist which raises doubts about the assumption that Dr. Heimlich is the inventor [of the Heimlich maneuver]."from "The Patrick Maneuver?" by "Holly Martins," heimlichinstitute.com

While the web of fake names, e-mail addresses, and phone numbers obscured the identity of Heimlich's tormentor, the content and tenor of the attacks began to provide clues about their author. There was something about the campaignin its form and its ferocity, in its penchant to begin with provable facts before spinning off into questionable, even wild, assertionsthat, in fact, seemed reminiscent of Heimlich's own work. In one last desperate attempt, Heimlich's investigator conducted a massive Internet search on the phone numbers, hoping to come up with a match. It was a digital fishing expedition, but the investigator got a bite. One of the phone numbers used by Heimlich's nemesis had also been used in an Internet classified ad for a 27-inch television and VCR. The seller was located in Portland, Oregon, and the company he owned was called Global Fabric. The seller identified himself as "Pete." The culprit, it turned out, was not one of Heimlich's old medical opponents. Rather, the person responsible for the "hate campaign" was his onetime greatest fan: his son, Peter.

Peter Heimlich is 53 years old. He is tall and thin like his father and has the same watchful eyes. When I went to meet him, he had moved from Portland and was living with his wife, Karen, in a gated community outside New Orleans. He invited me into his large house, which was filled with musical instruments, kitschy art, and reams of Heimlichrelated material. Peter explained that, in late 2001, his relationship with his father, which had gradually grown more distant, effectively came to an end. Peter believed his father was not paying sufficient attention to what he cryptically describes as "medical problems" in his family, and, when he approached his father with his concerns, he felt he was ignored. It was then that Peter, along with Karen, began what he calls their "project"an investigation into his father's career so far-reaching in its scope and so fevered in its conclusions that it has dominated their lives ever since.

"At the beginning, I'll be frank, I felt like I wanted to get back at my father," Peter said one afternoon, after he had spent the morning showing me the archive. "I was looking for a needle in a haystack, ... something I could just use against him." He began combing through the old newspaper articles and checking out medical journals from the library, searching for impropriety. It wasn't long before he thought he had found it. Indeed, Peter soon became convinced that the wrongdoing he had uncovered was so significant that his project became less a personal vendetta than an "ethical responsibility." He and Karen shuttered their fabric-importing company and devoted themselves to scrutinizing every chapter of Henry Heimlich's career. And, in the end, Peter concluded that everythingthe esophagus operation, the maneuver, the drowning cases, even the youthful heroism at the train wreckwas a fraud. "I don't think my father invented anything," Peter said, "but his own mythology."

Peter Heimlich is a dogged and resourceful researcher. He has meticulously documented a number of instances of his father's less than honorable behavior, including his promotion of the Heimlich maneuver for drowning and his malariatherapy work. But some of the most damning accusations Peter has leveled against his father appear to be based on a combination of conjecture, leaps of logic, and assumptions of almost epic bad faith. I spent several months trying to confirm Peter's most explosive allegationnamely, that his father did not invent the maneuver but stole it from a colleague named Ed Patrick. But the tantalizing scraps of information that sparked Peter's suspicions ultimately led me nowhere, and I eventually concluded the claim was unfounded or, at the very least, unprovable. (Patrick, for his part, has stated that he and Heimlich "worked together to develop" the maneuver, but he refuses to substantiate that claim.)

Peter is nearly the same age his father was when he achieved greatness with the maneuver. And, in his own quest, Peter has appropriated many of the tactics favored by the man he seeks to destroy. At the beginning of his project, Peter tried to work through official channelsfiling complaints against his father with several groups, including the Institute of Medicine, the National Academy of Sciences, and the Ohio Medical Board. When those groups failed to take action, he accused them of a cover-up and took his complaints to the press. Portraying himself as a real-life David doing battle with a Goliath-like "celebrity doctor," Peter has developed a small but loyal following among reporters, leading to a steady stream of news stories about his father's various (real and alleged) misdeeds. Last year, the Red Crosswithout explanationamended its First Aid guidelines, reinstituting backslaps as the primary choking treatment and relegating the Heimlich maneuver (or, as the organization now calls it, "abdominal thrusts") to secondary-treatment status. Peter boasts that these changes are at least partly because of him.

While he once waged his campaign in secretusing pseudonyms and talking to reporters only on the condition that he not be identifiedhe has now stepped out of the shadows. Indeed, Peter's project is no longer just about destroying what's left of his father's good name; it's also about making a name for himself. He believes that, in his project, he has found his true calling. "They're always saying you only use so much of your brain in life," he told me. "And I felt like here was something where I could put all my resources." On his websitewhich he changed from heimlichinstitute.com to medfraud.info, after the Heimlich Institute initiated legal actionhe now lists himself, not "Holly Martins," as the proprietor. He hopes in the future to become a guru of sorts, perhaps even an inspiration, to other whistle-blowersnot only in medicine but also industry and governmenthelping them with their efforts to expose wrongdoing. And, most important, he and Karen are writing a book. It will be, he said, "the unauthorized biography" of Henry Heimlich and the "authorized autobiography" of Peter Heimlich.

 

On a cold winter night in Cincinnati in 2005, several hundred people gathered in a hotel ballroom for the Cincinnati Business-Courier's annual Health Care Heroes awards banquet. Among the many honorees, the weekly business publication had selected Henry Heimlich as its "Lifetime Hero." The choice seemed uncontroversial enougha relatively meaningless honor (the awards are a marketing event) bestowed upon the city's most famous doctor in the twilight of his life. But, of course, nothing with Heimlich is uncontroversial these days. And, when Peter Heimlich learned of the Business-Courier's decision, about four weeks before the banquet, he besieged the paper with phone calls and faxes demanding the honor to his father be rescinded. The Business-Courier ultimately stood by its choice, but not without some awkwardness, publishing a defensive editorial a few days before the banquet that emphasized the award was being given to Heimlich solely for his anti-choking treatment.

The night before the awards ceremony, I met Heimlich in his condominium. My flight into Cincinnati had been delayed by snow, and it was already late in the evening when I arrived, but Heimlich ushered me into his living room and asked me to sit down. He clearly wanted to talk. It had been a trying period for Heimlich. A few months earlier, Peter had managed to persuade the organizers of the PanAfrica AIDS Conference, which Heimlich had addressed several times in the past, to disinvite him as a speaker; and a growing number of other doctors, egged on by Peter, had recently denounced him. "He's very clever," Heimlich said of his son, his voice mixed with both sorrow and a strange sort of admiration. "He always was. And that's part of the hurt. He has such talent." He added, "This has been the most painful part of my life."

But the more marginalized and embattled Heimlich was, the more defiant he became. Leaning forward in his chair, he launched into a diatribe against his critics. "I call these people medical assassins," Heimlich said. "They're nobodies, they've done nothing, and they want to get their names known, so they attack a person who is famous." It wasn't long before he was offering disquisitions on the Heimlich maneuver for drowning and malariatherapy. He stood up and began to pace the room. "I understand this struggle," he said, stopping and looking me hard in the eyes. "I've been having it for too long. And invariably I've succeeded, invariably I've succeeded."

The next night at the awards banquet, Heimlich seemed serene as he sat at a table with his wife, Jane, and his son Philwho, earlier that day, had told me that he fully supported his father and that his brother's behavior was "inappropriate and abusive." Heimlich laughed and talked with his tablemates throughout the meal. And, when it came time to deliver his acceptance speech, he kept it light and brief, mostly thanking Cincinnatians for taking him into theirs arms and supporting his endeavors. "[S]aving lives," he concluded, almost wistfully, "is still a worthwhile thing to do." After his speech, the ballroom began to empty, but a small crowd of people eagerly gathered around Heimlich. Pressing close to him, they told of relatives and friends who had been saved from choking by the maneuver. Then a woman stepped forward, and Heimlich stuck out his hand. But she brushed past it, opening her arms and embracing him. Heimlich smiled and wrapped his arms around her. "Thank you," he said, gladly accepting her gratitude. For one night, at least, it seemed to be enough.

Jason Zengerle is a senior editor at The New Republic.

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