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APRIL 23, 2007

The Choke Artist; Who are the mysterious critics hunting HenryHeimlich?

'A serious matter has been brought to my attention," the letterbegan. Addressed to an official in the Office for the Protection ofResearch Subjects at the University of California at Los Angeles,it accused two ucla medical researchers of participating in illegalhuman experiments on HIV patients in China. "These experimentsconsist of giving malaria to people already suffering from HIV andfull-blown aids," the letter alleged, before going on to make aneven more startling claim: "[T]hese experiments have been conductedunder the direction of Dr. Henry J. Heimlich, known for theHeimlich 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 epistolaryattacks against Heimlich. A few months later, editors at more than40 publications--ranging from The New York Times to the medicaljournal Chest--received missives from someone calling himself"David Ionescu" that accused Heimlich of improperly taking creditfor inventing a type of esophageal surgery. And then, in September2003, the website heimlichinstitute.com went online. Its URL wasalmost identical to the official website of Henry Heimlich'sHeimlich Institute, heimlichinstitute.org, but, rather than beingdedicated to burnishing the doctor's legend, it was devoted totearing it down. The site featured a long, angry indictment ofHeimlich and accused him of all sorts of medical misconduct. Thesite's proprietor was listed as "Holly Martins"--the protagonist inthe 1949 film noir The Third Man.

The octogenarian Heimlich seemed an unlikely target of so manypeople's ire. He had entered into the pantheon of medical historynot for inventing a disease- eradicating vaccine or for isolatingthe DNA of a killer virus but, rather, for developing ananti-choking maneuver that even a child could perform. And, yet, itis the very simplicity of Heimlich's lifesaving technique that makesit so ingenious; because anyone can perform the maneuver, anyonecan save a life. Since its invention in 1974, it has become astandard First Aid procedure around the world; and, while it mayhave been hyperbole for Norman Vincent Peale to once declare thatHeimlich "has saved the lives of more human beings than any otherperson living today," it was fair to say that, by the measure ofname recognition at least, the maneuver had made Heimlich America'smost famous doctor.

But, after the letters started arriving, Heimlich could no longerrest on such laurels. When I met him in his office at the HeimlichInstitute, he was under siege. Heimlich is tall and thin with asharp nose and watchful gray eyes, giving him an almost avianappearance. He wore a coat and tie and, as he sat at his desk, hetold me that he still put in a five-day work week--but what he wasworking on was unclear. The impressive-sounding Heimlich Institute,in fact, consisted of just two rooms in an administrative annexbehind Cincinnati's Deaconess Hospital. On the afternoon I visited,Heimlich had cajoled his old secretary, who had recently been laidoff due to lack of funds, to come in to help find some files forme; otherwise, he was the only person at the Institute.

And, yet, even in its diminished state, Heimlich's office served asan impressive testament to his unique stature. Framed cartoonstrips that referenced the Heimlich maneuver shared wall space withpictures of celebrities- -Cher, Elizabeth Taylor, RonaldReagan--who were saved by his anti-choking treatment. A giant toycaterpillar--"Heimlich," a ravenous character from the Pixar movieA Bug's Life--sat on the floor by his desk. Heimlich thumbedthrough a stack of newspaper articles. "I still get clippings frompapers 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 wouldtake the allegations seriously. Soon, though, the attacks began toexact a toll. Ucla launched an investigation into its researchers'work with Heimlich and ultimately found that one researcher hadviolated federal laws. Meanwhile, The Cincinnati Enquirer,Heimlich's hometown paper, ran a front-page story in which a rivaldoctor called Heimlich "a liar and a thief." Other doctors soonfollowed suit. Even the American Red Cross began to take a secondlook at the Heimlich maneuver. Heimlich and his family weretraumatized. "It's an incredibly painful and difficult thing forsomeone 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. Hehired a lawyer and an investigator to determine who was behind theallegations--or, as Heimlich called them, "the hate campaign." Itwas an investigation that would take months and frequently run intodead ends. For a reason that Heimlich did not yet understand--areason so shocking that, when he did discover it, it would shakehim to his core--his mysterious critics had gone to great lengthsto conceal their identities, wielding their anonymity as a potentweapon against his fame.

But, although he was pained by the attacks, in some ways Heimlichactually relished the confrontation--because he had never shiedaway from a fight. Lost amidst the tchotchkes and celebrity photosin his office that testify to the maneuver's success is the storyof just how hard he fought to get the medical establishment toaccept it in the first place. Indeed, Heimlich's achievement wasnot so much the maneuver itself but the vigorous and sometimesunderhanded campaign he waged to promote it. Heimlich's genius--onethat has been adopted lately by everyone from drug companies to warplanners--was to circumvent the experts and take his case directlyto the people. A showman as much as a scientist, a brawler as muchas a doctor, Heimlich was the P.T. Barnum of medicine--his careerserving as testament to the fact that even the supposedlyfact-based medical realm is susceptible to the phantom powers ofpersonality and salesmanship.

"This letter is to bring to your attention allegations that theInternational Society of Surgery, the World Journal of Surgery, andthe American medical journal, Diseases of the Chest, have beendefrauded by Dr. Henry J. Heimlich of Cincinnati, Ohio, USA, bestknown for the Heimlich maneuver."--letter from "David Ionescu,"April 3, 2003.

In 1963, a Florida coroner named Robert Haugen published an articlein the Journal of the American Medical Association that calledattention to a frequently overlooked medical problem. Haugendetailed the cases of nine Florida diners who each collapsed anddied while eating at a restaurant. Their deaths were initiallyattributed to natural causes, usually a heart attack. As Haugenwrote, it wasn't until his office performed an autopsy anddiscovered a large bolus of food lodged in each person'sairway--"steak in four cases, beef in two, ham fat in one, kipperedherring in one, and broiled lobster in another"--that the cause ofdeath was correctly determined to be asphyxiation. Haugen dubbedthis phenomenon "the cafe coronary" and implored the medicalcommunity to recognize choking as a serious problem.

Medical researchers began working to come up with an anti-chokingtreatment more scientifically advanced than the age-old backslap.One doctor invented the "Throat-E-Vac," which, after being insertedinto the victim's mouth and creating an airtight seal, supposedlysucked up whatever was obstructing the airway. Haugen himselfmarketed a nine-inch-long pair of plastic tweezers--the"ChokeSaver"--that would-be rescuers could use to grasp theoffending piece of food in the victim's throat and pull it out. Asthe public furor over choking grew--with radio stations runningpublic service announcements about the threat posed by "the cafecoronary"--it was clear that the doctor who devised a successfulanti-choking treatment would be hailed as a medical hero.

That Henry Heimlich found such a prospect appealing was hardlysurprising. He had experienced his first taste of the glory thatcomes to those who save lives in 1941, when, as a 21-year-oldpassenger on a New York City-bound train, he rescued a fellowtraveler after the train derailed in Connecticut--earning him amention on the front page of The New York Times and a gold watchfrom the Greater New York Safety Council. After serving as a Navydoctor in World War II, during which he volunteered for "prolongedextra-hazardous" duty in the Gobi Desert, he returned to New Yorkand specialized in thoracic surgery--a field that allowed him tohold a patient's beating heart in his hands. But even that provedunsatisfying. As a mere surgeon, Heimlich concluded, he was limitedto the finite number of people on whom he could operate. Bydevising new and revolutionary treatments and procedures, he couldexponentially increase the number of lives he saved.

Heimlich started off, in the mid-'50s, by introducing a surgery thatmade it possible for people with severe esophageal damage toswallow food. He called it the "Heimlich operation." Later, hedevised a chest drain valve that could be used to treat a collapsedlung, which he named the "Heimlich valve." In 1969, Heimlich, alongwith his wife Jane (daughter of the dance hall impresario ArthurMurray), his sons, Phil and Peter, and his twin daughters, Janetand Elisabeth, moved to Cincinnati, where he became director ofsurgery at the city's Jewish Hospital. It was there that he turnedhis attention to choking.

Heimlich still relishes telling the story of his most famousinvention. "No one was doing much about [choking] except for thesegadgets," he says, dismissively waving his hand. He set out todevelop a treatment that was, as he puts it, "so simple anybodycould do it." From his thoracic surgery experience, Heimlich knewthat at the moment of choking the lungs contained a substantialamount of air. He concluded that the best hope for devising apractical anti- choking treatment lay in harnessing that air toexpel whatever was lodged in the larynx.

Heimlich's research methods, at least with the benefit of 30 yearsof hindsight, seem comical. In his hospital's animal lab, hepartially anesthetized a 38-pound beagle--"the equivalent of havingthree or four good stiff drinks at dinner," he told his labtechnician. Next, he "strangled" it with a cuffed endotracheal tubeinserted into the larynx. Then Heimlich attempted to dislodge thetube. At first, he tried pressing on the dog's chest, but nothinghappened; with the beagle on the verge of death, he dejectedlyremoved the tube. Then inspiration struck. "I just got the idea thatif I push up on the diaphragm, the diaphragm comes up, the chestcavity decreases in volume, and that would compress the lungs,"Heimlich recalls. Sure enough, when he did just that, the tube flewout. He tried the same technique on three other beagles, each timewith the same result. Elated, he sent his lab tech down to thehospital commissary for some raw hamburger. That flew out of thebeagles' mouths, too.

Of course, all Heimlich had proved with his experiments was that hisanti- choking treatment worked on dogs. Whether it would work onhumans was an open question. Seeking an answer, Heimlich prevailedupon the editor of Emergency Medicine--a "throwaway" journal thatdid not require its articles to be peer- reviewed--to let himpropose his anti-choking treatment in its pages. Writing in theJune 1974 issue, under the headline "pop goes the cafe coronary,"Heimlich instructed would-be rescuers on how to perform themaneuver. He urged readers to report the results of their rescueattempts to him. The public would serve as both his researchers andhis subjects.

Heimlich made certain that a copy of his Emergency Medicine articlemade it to Arthur Snider, the Chicago Daily News's nationallysyndicated science writer. The week after Snider's article onHeimlich's proposed new anti-choking treatment appeared, a retiredrestaurant owner in Washington state used the new treatment to savehis choking next-door neighbor. "News article helps prevent achoking death" read the headline in The Seattle Times a few dayslater. Other Snider readers across the country made similarrescues, inspiring more headlines. But, despite the growing numberof positive anecdotal reports, not everyone jumped on the Heimlichmaneuver bandwagon. Based on the lack of hard scientific evidence,the American Red Cross--much to Heimlich's consternation-- wouldonly endorse the Heimlich maneuver as a secondary technique to beused if back blows were unsuccessful.

The only body that seemed capable of resolving the dispute betweenHeimlich and the Red Cross was the National Academy of Sciences. InJune 1976, the academy's Committee on Emergency Medical Servicesconvened a two-day conference on "Emergency Airway Management." Thecommittee 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 theconference's first day, Heimlich gave an impassioned speech,boasting of the more than 500 lives he said the maneuver had alreadysaved. After his presentation, nine conference participantsgathered in the academy's boardroom to try to reach an officialconsensus on choking treatments. For hours, they debated. Finally,as the clock ticked past midnight, they voted six to three in favorof 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 theconference that the group had been unable to obtain a "universalopinion." Heimlich stormed out of the conference. He was convincedhe had a proven lifesaving idea and that the only thing preventingthe medical establishment from accepting it was professionaljealousy. "These were the guys who were the experts ... but none ofthem, despite all their years of expertise, had come up with thisidea," Heimlich says with bitterness that, three decades on, stillseems fresh. "And then here comes this unknown guy in this fieldthat they've been working their whole lives in, and not only doeshe discover this thing, but it's named after him."

From this point on, Heimlich decided to bypass the medicalestablishment and to take his maneuver directly to the public. Hesold Heimlich maneuver posters and t-shirts (through a company hestarted with his son Phil) and made a slick film that featuredchoking actors being saved by his technique and a horror-movie-like score composed by his other son, Peter, a musician whoperformed in a band called "Choke." He barnstormed across thecountry, appearing on "The Tonight Show" and speaking tonon-medical groups about the maneuver. In his dark suits andconservative ties, Heimlich looked the part of a somber doctor. Buthis presentations were anything but dull. He told stories ofmiraculous rescues and cracked risque jokes while watching JohnnyCarson demonstrate the maneuver on Angie Dickinson; his speechesoften ended with a massive group hug as he asked everyone in theaudience to practice the maneuver on the person sitting next tothem. By the late '70s, a booking agency ranked Heimlich as one ofthe top ten public speakers in the United States. "The guy was adynamo," says Trevor Hughes, an anesthesiologist who became anoutspoken advocate of the maneuver. "It was like when you see atornado cutting across the plains or you come up against a force ofnature. ... His charisma was incredible."

Eventually, the Red Cross and the rest of the medical establishmentseemed to realize it was fighting a losing battle. AlthoughHeimlich still lacked much in the way of convincing laboratorystudies, he had managed to create a set of facts on the ground. In1985, Surgeon General C. Everett Koop proclaimed the Heimlichmaneuver "the only method" that should be used to treat chokingvictims. The next year, when the American Heart Association, inconjunction with the Red Cross, published its "Standards andGuidelines for Cardiopulmonary Resuscitation and Emergency CardiacCare," it recommended the maneuver as the primary anti-chokingtreatment.

Heimlich had won--making himself a household name in theprocess--but he had also created a number of enemies. Thanks toHeimlich's constant criticism of the organization, enrollment inthe Red Cross's first-aid classes dropped, and the organization hadits lawyers explore the possibility of suing him for slander. TheNational Academy of Sciences also suffered indignities: Heimlichhad declared backslaps "death blows" and accused the organization ofengaging in a cover-up--a "medical Watergate," he called it. Therewere also the individual doctors with whom Heimlich had tangled--heeven tried to initiate ethics proceedings against one doctor whoopposed the maneuver.

Thirty years later, Heimlich knew that the campaign against himcould have been the work of these old enemies. He told me he drewcomfort from the words of the Belgian poet Maurice Maeterlinck, whowrote, "At every crossway on the road that leads to the future,each progressive spirit is opposed by a thousand men assigned toguard the past." He thought about the many--if not necessarily1,000--men who had opposed him, and he tried to determine who wouldengage in such attacks today. He came up with a short list, whichhe conveyed to his lawyer, who in turn passed it on to theinvestigator. But the investigator soon determined that none of thesuspects were involved. Still, there was some progress. AlthoughHeimlich's tormentors had signed their attacks with fake names,employed multiple e-mail accounts and Web-hosting services fromfar- flung places (such as the Czech Republic), and used phonenumbers that were registered under even more pseudonyms, theinvestigator made the startling discovery that the attacks could betraced back to the same ISP number. In other words, Dr. Bob Smith,David Ionescu, and Holly Martins were likely the same person. Butif that person wasn't one of Heimlich's suspects, then who could itbe?

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

Heimlich had based his antichoking maneuver on little science butmuch intuition. And, because his intuition had proved correct, hispopulist campaign on the maneuver's behalf appeared heroic. It wasthe act of an innovative--if maverick--doctor who wanted to savelives right away instead of waiting for the medical establishmentto catch up and give his idea its seal of approval. In many ways,Heimlich's story--despite its rough edges--was inspirational. Butthat inspiration had a downside. What if Heimlich viewed hisexperience with the maneuver as a sign that he was uniquelyequipped, perhaps even destined, to solve other, even more pressingmedical problems? And what if Heimlich, convinced of his ownrightness, started up his publicity machine in order to sell thepublic another medical treatment, but, this time, his intuitionturned out to be incorrect?

In the early '80s, Heimlich, searching for an even granderlifesaving idea, became convinced there was another, wider-reachinguse for his maneuver. In 1974, a surgeon named Victor Esch claimedhe used Heimlich's anti-choking treatment to save the life of a manwho had nearly drowned on a Delaware beach. "[W]ater gushed out ofhis mouth and he began breathing," Esch reported. In subsequentyears, Heimlich received a handful of similar reports, and, in1985, he argued that the maneuver should replace CPR at a jointAmerican Heart Association-Red Cross meeting in Dallas, Texas.

As had been true nine years earlier at the National Academy ofSciences, Heimlich lacked any convincing scientific studies tosupport his claim, and he had even fewer anecdotal reports. Therewas also concern among drowning experts that the Heimlich maneuverwas potentially dangerous, since it would delay resuscitationefforts and was likely to induce vomiting, which can lead toaspiration pneumonia. And yet, the four other members of thedrowning panel agreed to add the maneuver to the drowning rescueprotocols as a secondary treatment. Heimlich's public fight overchoking seemed to play a role in their decision. "We were awarethat there was controversy over the prior set of guidelines onchoking," says Joe Ornato, the drowning panel's chairman and anemergency medicine doctor at the Medical College of Virginia. "Ididn't want anyone to potentially not have his life saved if itturned out Dr. Heimlich's idea was correct."

But Heimlich was not mollified. He continued to agitate for themaneuver to replace CPR as the primary near-drowning treatment,and, eventually, the Institute of Medicine (IOM)--the nation'sleading medical advisory group-- agreed to give him a hearing. In1993, Heimlich testified before an IOM committee. "[Heimlich] kindof impressed me as a guy who doesn't really know anything aboutresearch science," says Peter Rosen, who chaired the IOM committeeand was then an emergency medicine doctor at the University ofCalifornia at San Diego. "It was an old man telling tales." The IOMcommittee's subsequent report concluded that there was no goodevidence to support the routine use of the Heimlich maneuver ondrowning victims.

Just as he had done during his fight over choking, Heimlich decidedto circumvent the medical establishment. In 1995, he appeared at aU.S. Lifesaving Association seminar and urged the assembledlifeguards to ignore the American Heart Association guidelines asan act of conscience, adding, "I think the Nuremberg trials toldthe story that no one can be excused for saying, 'I was ordered todo so or was taught to do so, to kill people.'" That same year,Jeff Ellis & Associates, the nation's largest private lifeguardcompany--which staffs many of the nation's major water parks andtrains about 35,000 lifeguards annually--began teaching themaneuver as a first response. It continued to do so for the nextfive years, until a reporter for the water park industry trademagazine Fun World wrote a story documenting the questionablescience behind Heimlich's crusade.

There is much speculation in the lifesaving community that Ellis'sfive-year embrace of the Heimlich maneuver compromised safety atthe company's facilities, and there are rumors of rescues that wentawry. An Ellis spokesperson refused to answer any questions aboutthe company's experience with the maneuver. But James Orlowski, apediatrician in Tampa, Florida, who has tracked the use of theHeimlich 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" results-- from stomach rupture to aspirationpneumonia to death. Orlowski says he knows of no instances wherethe maneuver saved a near-drowning victim.

Ellis's decision to drop the maneuver from its protocol was a severeblow to Heimlich. But he turned to his supporters for solace--nonemore so than his family. Although Heimlich still had many admirersamong the general public, their regard for him could never approachthe larger-than-life status in which his family held him. Hiseldest son Phil, who went from selling Heimlich maneuver t-shirtsto a successful legal career to an eventual seat on the Cincinnaticity council, credits his father for his decision to go intopolitics. "He really inspired me, because he used his abilities tohave 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 tocarry on his father's good name, Heimlich's younger son Petertoiled privately. Having left Cincinnati to live in San Franciscoand then Portland, Oregon, Peter typically only saw his father whenthe doctor visited the West Coast--tagging along with him to "TheTonight Show." But Peter--who eventually put aside his musicalambitions to start a business with his wife importing fabrics fromAsia--stayed close to his father in another way. For years, Henrywould send Peter newspaper clips and medical journal articles abouthis latest accomplishments, and Peter would dutifully save everyone--until he had assembled what may be the world's largest privatearchive 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, isreminiscent of the Tuskegee syphilis research atrocities. Yet,according to Heimlich, Chen, et al., denying other treatments totheir Chinese research subjects was a condition of participation intheir study."-letter from "Dr. Bob Smith," October 2, 2002.

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

Of all the battles Heimlich has waged, none has proven ascontroversial as malariatherapy--the practice of intentionallyinfecting a patient with malaria in order to treat another ailment.And yet, perhaps because of its controversial nature--to saynothing of its grandiosity--malariatherapy is the medical crusademost dear to him. Like all of Heimlich's endeavors, malariatherapydoes have one foot in the realm of legitimate science. In 1917, theAustrian psychiatrist Julius Wagner von Jauregg proved that amalaria- induced fever would kill the syphilis micro-organism aftertesting the theory on patients. Malariatherapy soon became thestandard treatment for neurosyphilis, and, in 1927, Wagner vonJauregg was awarded the Nobel Prize in medicine for his work. Thediscovery of penicillin in the 1940s, however, renderedmalariatherapy obsolete, and it was eventually abandoned as amedical treatment. But, in the mid-'80s, Heimlich startedcampaigning to resurrect the practice--not as a treatment forneurosyphilis but as a means to fight other, more intractable,diseases.

His first target was cancer. Although he had no expertise inoncology, Heimlich's idea of treating cancer with malariatherapywas not immediately dismissed. The Centers for Disease Control(CDC) even invited him to Atlanta to discuss it. But the CDC wasultimately unwilling to supply Heimlich with malariainfected blood,so he took his work across the border. In 1987, he persuadeddoctors at the Mexican National Cancer Institute in Mexico City tobegin treating five patients with malariatherapy. The results werenot 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'twork on cancer, he believed there were other afflictions that itmight cure. In 1990, he published a letter in The New EnglandJournal of Medicine suggesting malariatherapy as a treatment forLyme disease. It wasn't long before "Lymeys" from as far away asHungary were requesting the treatment from Heimlich. But, when aNew Jersey woman who was one of his first Lyme patients laterdenounced Heimlich--"[I]f anybody ever asked me about Dr. Heimlichand his supposed cure, " she said, "I wouldn't hesitate to tellthem to run away fast"--the tightly knit Lyme community turnedagainst malariatherapy.

Nothing, however, could shake Heimlich's faith. In fact, each timemalariatherapy failed, his ambitions for it seemed to grow--so muchso that, by the early '90s, he was touting it as a solution toarguably the world's most pressing medical problem: aids. Eminentimmunology experts, such as the director of the National Institutefor Allergy and Infectious Diseases, Anthony Fauci, dismissedHeimlich's idea as "quite dangerous and scientifically unsound. "But Heimlich did not need their support. All he needed was money anda place to try out his idea. In Hollywood he found the former; andin China he found the latter. Using private donations fromprominent members of the entertainment industry--including AmyIrving and Estelle Getty--Heimlich established a malariatherapyclinic for HIV patients in Guangzhao, China. There, beginning in1994, a team of four Chinese doctors injected at least eight HIVpatients with malarial blood; for each patient, the HeimlichInstitute provided the doctors between $5,000 and $10,000 infunding.

In 1996, Heimlich went to the eleventh International Conference onaids in Vancouver and made a stunning announcement. He reportedthat the CD4 counts-- which are depleted as HIV progresses toaids--in two of the Chinese HIV patients had increased after acourse of malariatherapy and that the counts remained high twoyears later. Before the Vancouver conference, he had stopped inPortland to visit Peter, to whom he had touted his China study."This will put us over," he told his son. But, when aids expertslooked closely at Heimlich's results, they saw that the test theChinese doctors had employed to measure CD4 levels was notoriouslyunreliable--rendering the data useless. After a falling out withthe Chinese doctors, Heimlich began searching for other countrieswhere he could do a clinical trial, but no one was interested.

Two years ago, Heimlich changed the name of malariatherapy. "Peoplehear malaria and they shy away," he explained to me, "so we'll callit immunotherapy. " Heimlich was seated in a large recliner, and,since he was working from home that day, he wore a plaid shirt andan old pair of blue bedroom slippers. For more than an hour, heflipped through the binders and read me portions of various medicalstudies that he said proved malariatherapy--as he still frequentlycalled it--works. "So we're not without evidence," he said. But,when I later read the studies in their entirety, they showed no suchthing; Heimlich was cherry-picking the passages that seemed tosupport his position. His method reminded me of something PeterRosen, the emergency medicine doctor who clashed with him overdrowning, had told me. "One of the differences between people whodo science and people who don't is the people who do sciencerealize that what you're trying to do in science is falsify ahypothesis," Rosen said. "And only after you examine all sorts ofevidence and you can't falsify a hypothesis do you establish thatthe hypothesis is true. The people trying to prove a hypothesislook at any piece of positive evidence and then stop. Heimlichnever understood that distinction."

As Heimlich droned on, he seemed more pathetic than dangerous--justan old man telling tales, one whose crackpot theories would,thankfully, never gain currency or be put into practice again. Butthen Heimlich opened his last binder, which was markedconfidential, and pulled out two sheets of paper. "Now I will tellyou about the malariatherapy, or immunotherapy as we now call it,in Africa." He began to read from one of the sheets. "The HeimlichInstitute has been collecting CD4 and viral load data on patientswho are HIV-positive and have become infected with malaria. Thisdata will provide support for the concept of using malariatherapyfor treating HIV infection." The study involved the questionablepractice of initially withholding treatment for malaria, soHeimlich would not tell me where in Africa this new malariatherapytrial was being done. "You never know how the politicians willreact in these countries," he explained. But, according to a publichealth physician who has worked on aids in East Africa and hasknowledge of Heimlich's latest project, the study site is inEthiopia. An official with the Ethiopian Ministry of Health told methat the ministry is unaware of any malariatherapy work beingconducted in the country and that, if it is, it is being donewithout proper notification and permission.

Still reading from the papers, Heimlich boasted about the study'searly results. Six of the first seven HIV patients treated withmalariatherapy, he claimed, had experienced decreases in theirviral loads. Now he was eagerly anticipating results from the 42other patients in the study. He seemed to have little doubt aboutwhat those results would be. "I've been right in just abouteverything I've done," Heimlich said. "And when it gets to somethinglike this, I know."

"Evidence does exist which raises doubts about the assumption thatDr. 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 numbersobscured the identity of Heimlich's tormentor, the content andtenor of the attacks began to provide clues about their author.There was something about the campaign--in its form and itsferocity, in its penchant to begin with provable facts beforespinning off into questionable, even wild, assertions--that, infact, seemed reminiscent of Heimlich's own work. In one lastdesperate attempt, Heimlich's investigator conducted a massiveInternet search on the phone numbers, hoping to come up with amatch. It was a digital fishing expedition, but the investigatorgot a bite. One of the phone numbers used by Heimlich's nemesis hadalso been used in an Internet classified ad for a 27-inchtelevision and VCR. The seller was located in Portland, Oregon, andthe company he owned was called Global Fabric. The selleridentified himself as "Pete." The culprit, it turned out, was notone of Heimlich's old medical opponents. Rather, the personresponsible 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 fatherand has the same watchful eyes. When I went to meet him, he hadmoved from Portland and was living with his wife, Karen, in a gatedcommunity outside New Orleans. He invited me into his large house,which was filled with musical instruments, kitschy art, and reamsof Heimlichrelated material. Peter explained that, in late 2001,his relationship with his father, which had gradually grown moredistant, effectively came to an end. Peter believed his father wasnot paying sufficient attention to what he cryptically describes as"medical problems" in his family, and, when he approached hisfather with his concerns, he felt he was ignored. It was then thatPeter, along with Karen, began what he calls their "project"--aninvestigation into his father's career so far-reaching in its scopeand so fevered in its conclusions that it has dominated their livesever since.

"At the beginning, I'll be frank, I felt like I wanted to get backat my father," Peter said one afternoon, after he had spent themorning showing me the archive. "I was looking for a needle in ahaystack, ... something I could just use against him." He begancombing through the old newspaper articles and checking out medicaljournals from the library, searching for impropriety. It wasn'tlong before he thought he had found it. Indeed, Peter soon becameconvinced that the wrongdoing he had uncovered was so significantthat his project became less a personal vendetta than an "ethicalresponsibility." He and Karen shuttered their fabric-importingcompany and devoted themselves to scrutinizing every chapter ofHenry Heimlich's career. And, in the end, Peter concluded thateverything--the esophagus operation, the maneuver, the drowningcases, even the youthful heroism at the train wreck--was a fraud. "Idon't think my father invented anything," Peter said, "but his ownmythology."

Peter Heimlich is a dogged and resourceful researcher. He hasmeticulously documented a number of instances of his father's lessthan honorable behavior, including his promotion of the Heimlichmaneuver for drowning and his malariatherapy work. But some of themost damning accusations Peter has leveled against his fatherappear to be based on a combination of conjecture, leaps of logic,and assumptions of almost epic bad faith. I spent several monthstrying to confirm Peter's most explosive allegation--namely, thathis father did not invent the maneuver but stole it from acolleague named Ed Patrick. But the tantalizing scraps ofinformation that sparked Peter's suspicions ultimately led menowhere, and I eventually concluded the claim was unfounded or, atthe very least, unprovable. (Patrick, for his part, has stated thathe and Heimlich "worked together to develop" the maneuver, but herefuses to substantiate that claim.)

Peter is nearly the same age his father was when he achievedgreatness with the maneuver. And, in his own quest, Peter hasappropriated many of the tactics favored by the man he seeks todestroy. At the beginning of his project, Peter tried to workthrough official channels-- filing complaints against his fatherwith several groups, including the Institute of Medicine, theNational Academy of Sciences, and the Ohio Medical Board. Whenthose groups failed to take action, he accused them of a cover-upand took his complaints to the press. Portraying himself as areal-life David doing battle with a Goliath-like "celebritydoctor," Peter has developed a small but loyal following amongreporters, leading to a steady stream of news stories about hisfather's various (real and alleged) misdeeds. Last year, the RedCross-- without explanation--amended its First Aid guidelines,reinstituting backslaps as the primary choking treatment andrelegating the Heimlich maneuver (or, as the organization now callsit, "abdominal thrusts") to secondary-treatment status. Peterboasts that these changes are at least partly because of him.

While he once waged his campaign in secret--using pseudonyms andtalking to reporters only on the condition that he not beidentified--he has now stepped out of the shadows. Indeed, Peter'sproject is no longer just about destroying what's left of hisfather's good name; it's also about making a name for himself. Hebelieves 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 putall my resources." On his website--which he changed fromheimlichinstitute.com to medfraud.info, after the HeimlichInstitute initiated legal action--he now lists himself, not "HollyMartins," as the proprietor. He hopes in the future to become a guruof sorts, perhaps even an inspiration, to otherwhistle-blowers--not only in medicine but also industry andgovernment--helping 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 peoplegathered in a hotel ballroom for the Cincinnati Business-Courier'sannual 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 enough--arelatively meaningless honor (the awards are a marketing event)bestowed upon the city's most famous doctor in the twilight of hislife. But, of course, nothing with Heimlich is uncontroversial thesedays. And, when Peter Heimlich learned of the Business-Courier'sdecision, about four weeks before the banquet, he besieged thepaper with phone calls and faxes demanding the honor to his fatherbe rescinded. The Business-Courier ultimately stood by its choice,but not without some awkwardness, publishing a defensive editoriala few days before the banquet that emphasized the award was beinggiven to Heimlich solely for his anti-choking treatment.

The night before the awards ceremony, I met Heimlich in hiscondominium. My flight into Cincinnati had been delayed by snow,and it was already late in the evening when I arrived, but Heimlichushered me into his living room and asked me to sit down. Heclearly wanted to talk. It had been a trying period for Heimlich. Afew months earlier, Peter had managed to persuade the organizers ofthe PanAfrica aids Conference, which Heimlich had addressed severaltimes in the past, to disinvite him as a speaker; and a growingnumber of other doctors, egged on by Peter, had recently denouncedhim. "He's very clever," Heimlich said of his son, his voice mixedwith both sorrow and a strange sort of admiration. "He always was.And that's part of the hurt. He has such talent." He added, "Thishas been the most painful part of my life."

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

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

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