Warning: Chewing on This May Cause Choking
At first, I wasn’t going to devote a column to this. Rather, I was just going to email my research and thoughts to the reader who complained about an online article on the PBS NewsHour site, and to the editors of that article.
But almost everything about this episode is strange, the central figure is very well known, and so are the sights and sounds of someone who suddenly chokes on something at a restaurant or dinner table. So here goes.
On June 16, an online PBS NewsHour column marked the 40th anniversary of the now famous “Heimlich Maneuver,” an emergency life-saving method of grasping a choking victim from behind and administering quick abdominal thrusts to dislodge and expel whatever is blocking the airway. The maneuver was developed by Dr. Henry Heimlich in the early 1970s.
The author of the article is Dr. Howard Markel, who, according to the description on the piece, writes a monthly column for the NewsHour highlighting the anniversary of a momentous event that continues to shape modern medicine. Markel is the author of several books and is the director of the Center for History and Medicine and Distinguished Professor of the History of Medicine at the University of Michigan. The digital news editor at the NewsHour handling the online column is Margaret Myers.
I read the article after it was called to my attention, and I found it informative and balanced, telling me a fair amount in a fairly brief space (about 1,000 words) about a household name. It told me a lot that I didn’t know, especially about controversies surrounding Henry Heimlich's career.
For example, it told me that although Heimlich was awarded one of the most prestigious awards in American medicine and public health in 1984, and that his Heimlich maneuver was the recommended emergency treatment for choking victims for about 20 years, that in 2006 the American Red Cross “downgraded” it to include “back blows” before abdominal thrusts.
It told readers that by 1988, Heimlich was recommending use of abdominal thrusts for drowning victims “even though he had little data to support such an assertion” and that such advice “has since been abandoned and is now considered by many physicians to be dangerous.” For several years, Dr. Markel reported, Heimlich also “advocated treating patients with cancer, HIV and Lyme disease by infecting them with malaria but both his theories and research on this issue have long since been discredited.”
And then there was this: In 2003, Heimlich’s longtime colleague Dr. Edward Patrick issued a press release saying that he was the uncredited co-developer of the maneuver.
So this was not some anniversary puff-piece. But Markel reminds his readers, that “controversies aside, the Heimlich maneuver has helped to save countless lives over the past four decades.”
And aside from Dr. Patrick’s claims, Markel writes: "More troubling, Heimlich’s son, Peter, has long curated a website refuting his father’s contributions to modern medicine and referring to his father as 'a spectacular con man and serial liar,'" and Markel provides a link to the son’s website.
Here’s where the plot, and the stack of emails, thickens. Peter Heimlich writes to Myers and Markel asking that a series of corrections to the article be posted and asking for details on the source of various citations. Heimlich seems not only a relentless deconstructionist of his famous father’s work but apparently wants to make sure that anything anyone else writes, even if partially critical, is correct in the eyes of the son. They exchange emails. Nobody is satisfied. Enter the ombudsman.
Heimlich writes to me to determine if Markel's and Myers' actions are in compliance with PBS standards and guidelines, wants Markel to provide various citations, and takes a shot at Myers for refusing “to correct provably false information.” He claims there are two factual errors and two possibly unsubstantiated claims in the column.
Myers argues that this is a blog, not an academic paper or a Wikipedia entry, that it links to Peter’s website, that the column was not intended to “go into the weeds over Peter Heimlich’s claims,” and that what they wrote is “not incorrect” and so they “chose to leave it [the posting] as is.” She had also told Heimlich, “Dr. Markel and I have discussed the story again and we stand by it as it is. The story is a snapshot of Dr. Heimlich and we mention all the relevant issues surrounding his body of work.”
I’m not a big fan of “not incorrect” as a posting or editing approach but, as in most things, this is a complicated issue. I took the points Heimlich sent to me and forwarded them to the online NewsHour for a response.
What follows are the challenges offered by Peter Heimlich in his email to me—represented by lines from the text of the online article highlighted in bold-faced italics—and then the responses from Dr. Markel.
1) By 1988, Dr. Heimlich was recommending the use of abdominal thrusts as a treatment for drowning....
Heimlich says, as he says he informed Dr. Markel in a June 16 e-mail, "my father first started circulating his dubious drowning rescue claims in an August 24, 1974 Chicago Daily News article by reporter Art Snider. The record clearly demonstrates that for the next four decades, my father relentlessly promoted the treatment. Per a February 7, 2014 interview he did with the Boston Globe, my father continues to do so."
Dr. Markel responds: Heimlich did, indeed, advocate his maneuver for drowning victims for a long time. I suggest Mr. [Peter] Heimlich check the records of the American Red Cross and the archives of the American Red Cross, where the original recommendation was heatedly discussed and made during the 1980s. Yet he notes that Heimlich may have discussed this use for drowning as early as 1974 in a discussion with Art Snider. While the piece [the online article] can be changed, for Mr. Heimlich's comfort, to state that from "the mid-1970s to the late 1980s, Dr. Heimlich recommended his maneuver for drowning victims," I would not cite Snider's piece, per se. Snider is merely the reporter reporting on Heimlich's "medical advice." Dr. Heimlich may have spoken to other reporters as well. Therefore, to suggest a primacy on Snider's part is potentially misleading.
2) For several years, Dr. Heimlich also advocated treating patients with cancer, HIV and Lyme disease by infecting them with malaria....
Heimlich, referring again to his June 16 e-mail to Dr. Markel, says, to my knowledge the first published report in which my father advocated infecting patients with malaria was in the Wall Street Journal on April 30, 1982, in an article by Michael L. King titled: Dr. Heimlich Can Fix Choking Fast; Here's What Else He Treats; Unconventional Surgeon Puts War Under the Knife, Has Novel Cure for Cancer, Too. In approximately 1990, my father began decades of clandestine offshore "malariotherapy" experiments on U.S. and foreign patients which resulted in investigations by the Centers for Disease Control and Prevention (1990-93), the Food and Drug Administration (1999), the Department of Justice (1994), and UCLA (2003)…[and in] my father's recently-published memoir, he continues to advocate “malariotherapy.” Needless to say, 1982-2014 is not “several years” – it's 32 years. Despite being made aware of this information, in a June 17 e-mail, Ms. Myers stated that she and Dr. Markel refused to correct the error.
Dr. Markel replies: The malariotherapy was mentioned by Dr. Heimlich many times -- not only in the WSJ but also in his memoir on the American Broncho-Esophogeal Society, in other interviews with the press, at medical meetings, and to many, many other media outlets. I agree it's not a good means of treating AIDS, cancer, etc., and precisely state that his theories were discredited by the medical establishment. But Mr. Heimlich's specific complaint here comes down to this: I use the term "several years" to describe this phase of his father's career while Mr. Heimlich prefers the term "for decades." I do not find the two terms as mutually exclusive as he does. I see no reason to cite the WSJ article he mentions. This is not a scholarly article with footnotes!
3) In 1972, the New York Times reported that more than 3,000 people in the U.S. choked to death that year, making it the sixth most common cause of accidental death. Up until that time, the usual response upon discovering a choking person was to slap him or her on the back.
Heimlich says he had asked Dr. Markel to provide him with a copy of the New York Times article. In a June 17 e-mail, Ms. Myers wrote me that it was published on Sept. 17, 1972. She did not provide the title, author, a copy of the article, or any indication that she had read the article.
Dr. Markel responds: The NY Times published an article on accidental deaths on September 17, 1972. I used this reference because Dr. Heimlich stated in several interviews that he read an article on the topic in the NY Times in 1972. This article really emerges from a National Academy of Sciences study, which is easy to find at any university library. But more important these studies and statistics are reported EVERY year by many different sources. Therefore, I see no reason to cite the source beyond what I have done. It is simply not the way I have written these pieces for PBS. If we want to add footnotes, I can certainly do that but this seems a bit much for a blog.
(Ombudsman’s note: When he first wrote to Myers for a copy of the referenced New York Times article, Peter Heimlich put his request this way…"to save me a search." And the NewsHour apparently didn’t or wouldn’t search either. But it took my adroit assistant, Marcia Apperson, about two minutes to dig out a Sept. 17, 1972, front-page article by Lawrence K. Altman headlined “Science Academy Assails Nation’s Emergency Care.” It contains nothing about choking deaths and no numbers.)
4) But many doctors insisted that a blow on the back tends to drive the object downward, lodging that obstruction even more tightly in the airway.
Heimlich asked Dr. Markel to provide him with names of some of the doctors who took this position, prior to 1972.
Dr. Markel responds: Several going as far back as Hippocrates! In the American context, Samuel Gross of Philadelphia in the mid-1840s, Theodor Billroth of Vienna in the 1890s, Moses Gunn of Ann Arbor in the 1860s, John Harvey Kellogg of Battle Creek in the 1880s -- and I might add myself, Howard Markel, in the 1980s. Indeed, it was an observation I made many times when treating choking victims in the ER. The point here is that many doctors made the observation rather than my providing a roll call of all those in history who noted this problem. I really find this query odd in that the essay focuses on Dr. Heimlich, not other doctors across time who treated choking victims [which is practically every doctor!]
(Ombudsman’s note: Not to be deterred, Peter Heimlich then asked for citations relevant to those doctors’ positions. Nobody has answered yet, including me.)
In an earlier exchange, Heimlich also cited and questioned this line from the article: Controversies aside, the Heimlich maneuver has helped save countless lives over the past four decades…He said that he did so because “as far as I can tell from NSC [National Safety Council Statistics], per capita choking deaths in our country have remained virtually unchanged since decades before and decades after my father introduced ‘the Heimlich.’”
Dr. Markel responds: I will stick with the "countless" lives saved by the Heimlich maneuver. We don't have a count, period, which means its "countless." These events rarely occur in clinical settings and no public health agency, to my knowledge keeps accurate statistics on its use. Mr. Heimlich's note that there are still the same number of choking deaths each year is not the way to go about proving his point. To begin, there are more people living today than 30 years ago, more people eat outside the homes and there are bigger dining portions in many parts of the world, etc. We just do not have good data. Hence, the word countless. I realize Mr. Heimlich wants to eliminate hype from the story but I won't misreport a story by attaching a quantitative number to the actual number of people who have been "Heimliched" over the past decade. And more importantly, every practicing doctor would agree that in terms of treating choking from a mis-swallowed piece of food, the Heimlich Maneuver works. It is the only way to treat a choking victim? No, that's why I tell the reader to look into the new ARC guidelines.
I don’t see this as rising to a charge of non-compliance with PBS standards and guidelines. I think a fair-minded reader would find this article as a whole to be, as I did, a brief but informative treatment of a household name and maneuver that doesn’t let celebrity overshadow controversy.
But I do think that this unusual and intense challenge by the famous doctor’s son (and his wife, Karen, who assists in the research) raised worthwhile questions and made some good points. For example, Dr. Markel and Myers clearly could have spent some time to check out the New York Times article and archive, and Heimlich could have as well unless he already knew the piece was not about choking. I also think Dr. Markel needs to check out the meaning of “several,” as in several years. It doesn’t mean decades. Dr. Markel is a medical historian so I trust (hope) that he knows what he’s talking about in his citation of those doctors of an earlier time.
I didn’t see the timing issues raised by Peter Heimlich, in contrast to those used in the article by Dr. Markel, as rising to the level of requiring a formal correction. But the New York Times citation, or whatever it was that the senior Heimlich was referring to, could have been and should have been tracked down and at least clarified. And Peter Heimlich’s points about the timing of his father’s early public advocacies, even though they may have been in newspapers, would have made an interesting paragraph or two posted on the blog. In sum, dealing at least briefly with the Times citation and one or two of Peter Heimlich's points, especially considering who he is, would have made an interesting post comment.
I, clearly, did not do this briefly because I felt an obligation to air the points of both sides. But one could easily imagine summing up the challenges in one or two paragraphs.
Posted at 3:53 p.m.