The Sidebar: May 2017

Monday, May 29, 2017

UK crowdfunding effort to install anti-choking devices in Yorkshire schools derailed by government-initiated medical review [UPDATED]

JUNE 17, 2017 UPDATE: Paper Trail: How a UK government-initiated medical review choked Yorkshire group's attempt to install anti-choking devices in local schools

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Three months after hosting a JustGiving crowdfunding campaign to purchase and donate an anti-choking device to local schools, the Hull Wyke Round Table (HWRT) -- a charitable organization in Yorkshire, England -- has sent donors a refund offer letter.

The failed project raised couple of thousand pounds -- including two quid I kicked in.

The project was cancelled after a comprehensive medical review by a local government's public health department in partnership with area hospitals.

But the HWRT's refund letter doesn't mention that -- and it's unclear why not.

The story begins with a February 4 Hull Daily Mail news report about a tragic death:

A five-year-old boy has died after choking on his food during a school lunch break [yesterday] at Anlaby Primary School.

Via a February 10 follow up story in the same paper:

Hull Wyke Round Table (HWRT) has raised enough money to fit primary schools in Hull and East Riding with life saving anti-choking devices.

The charitable organisation has raised enough money to install LifeVac units in 17 primary schools in west Hull and East Riding. They are now looking to raise more money to install more devices in more schools.

In other words, in less than a week the HWRT apparently came across the LifeVac device, evaluated its efficacy and safety, and raised an unreported amount of money from an unreported source to install it in 17 schools.

If the Hull reporter looked into any of those details, they're not in the article.

In any event, let's call that Round One of the fundraising by the HWRT, an organization which, according to its website, apparently has no fixed address, phone number, or e-mail address.

The article in the Hull newspaper then reports what I'll call Round Two of the fundraising project and instructs readers how to contribute:

They are now looking to raise more money to install more devices in more schools.

...HWRT member Edd Wheldon said: "I came across this device and we thought we would like to offer to install them in primary schools in our area.

"We just thought it might be something which could help prevent tragedies from happening."

...Wheldon said the supplier had also offered to visit each school interested in having it installed to train staff members. In a letter to the schools' headteachers, Mr Wheldon asked them to confirm whether they would like a unit by February 17.

You can donate to the project online here.

The link in the last sentence leads to the HWRT's fundraising page hosted by the popular crowdfunding platform JustGiving.com.

Here are the first donations, indicating that the campaign began on February 9, just five days after Hull newspaper reported the choking tragedy.

Based on responses to FOIA requests, on February 9 Edd Weldon circulated the following e-mail to local schools in which he offered a "Wall Mounted (LifeVac) kit to be mounted in your dining area. The supplier has also agreed to come and give you a training session of the product at a central location hosted by Hull Wyke Round Table."

Interested parties were instructed to contact LifeVac representative Eric Banagan "if you have any technical questions."

Click here to download a copy of Wheldon's e-mail to the schools which included three pdfs consisting of about 50 pages of materials that appear to have been provided by LifeVac, including a June 14, 2016 North Devon News article about a nurse who claims she used the device to save the life of a choking woman at a nursing home in Llanybydder, Wales.

Wheldon's letter claimed, "This device is already in 100 schools in the UK and has saved three lives recently."

The same claims were in HWRT's JustGiving fund raising solicitation.

Per my March 7, 2017 item, when I asked Wheldon for details about the three saved lives and a list of the 100 schools, I didn't receive a reply.

Back to the crowdfunding campaign which ended February 28 -- here's the result:

Fast forward two months to this May 15 update on the crowdfunding page informing donors that the project had collapsed:

The link (my yellow highlighting) leads to this unsigned letter -- click here to download a copy -- with no return address or phone number, but provides this e-mail address: lifevacroundtable@googlegroups.com

Here's what the HWRT letter claims went wrong:

Presumably the HWRT failed to ask the UK Medicines and Healthcare products Regulatory Agency (MHRA) for that information before initiating the fundraising project.

And the HWRT doesn't apologize to donors or the schools for failing to perform such minimal due diligence.

It's also unclear why the HWRT finds the MHRA's position to be "disappointing." That is, why would they want to install an unapproved medical device in local schools?

But the letter inexplicably fails to tell donors the real reason the project was derailed.

In response to HWRT's fundraising, the local government East Riding of Yorkshire Council initiated an expert medical review, the results of which were circulated to area schools in the following March newsletter.

Via the newsletter -- click here to download a copy.

(Guidance) has been obtained through the Councils Public Health team, in partnership with Hull and East Yorkshire Hospitals (HEY), who have comprehensively reviewed the use of such devices particularly in a paediatric context.

It is recommended at this time that the device is not used until further evidence on suitability for paediatric use is published.

According to the e-mails below, Wheldon was aware of the Council's findings on March 16, two months before the May 15 refund letter. What took his organization so long to offer refunds to me and other donors?

Why didn't the HWRT's refund letter inform donors about the medical review (which, incidentally, is apparently not available via the Council's website)?

What happened to the money the HWRT raised in Round One of the fundraising?

When and how did Edd Wheldon "(come) across the device" as he told the Hull Daily Mail?

And what due diligence did his organization conduct before initiating a project that wasted the time of the schools, local government, and donors, and which presumably resulted in taxpayers paying for the medical review?

Wednesday, May 10, 2017

UK tabloid claims actor Halle Berry's life was saved by "the Heimlich" -- but she debunked that years ago; here's what happened when I requested a published correction

Halle Berry (source)

In his 2014 memoir, my dad claimed that actor Halle Berry was saved from choking by "the Heimlich."

But via an award-winning Hollywood Reporter article, she denied the claim.

December obituaries for my father in the New York Times and BuzzFeed included the false "Halle was Heimlich-ed" claim, but, in response to my requests, both news outlets published thorough corrections.

At the same time, the UK's Daily Express tabloid published the bogus claim, but the paper ignored my corrections requests.

So I filed a complaint with UK's Independent Press Standards Organization.

source

This seemed so straightforward, I assumed it would be a slam dunk.

Plus I was motivated because it would add to my tally of successful, possibly record-making corrections requests as reported in January by Erik Wemple at the Washington Post.

But in a determination that reads like something out of Lewis Carroll, yesterday IPSO wrote me that the factual error published by the Express wasn't "significantly misleading."

Huh?

It was significantly misleading enough to Ms. Berry.

She told the Hollywood Reporter it was baloney.

In response to the determination, a representative from the Express's legal office thanked IPSO and left the lie uncorrected.

In other words, the paper has made clear that they are intentionally providing false information to readers.

Some skeptics may claim that's not unusual, but how often do you get an empirically provable example like this?

Further, by failing to correct the error, the Express has tacitly admitted that its editorial standards are below the New York Times and BuzzFeed.

Perhaps no surprise there, but how often do you get a bulletproof example?

As for IPSO, based on their determination, apparently they hold their member organizations to a lower editorial standard than the New York Times and BuzzFeed.

Those are just some of the points I raised in my appeal today to IPSO which includes links and screenshots documenting my trip down this UK journalism rabbit hole. Click here to download a copy.

This item has revised.

Monday, May 8, 2017

My father's being inducted into the New Rochelle, NY, "Walk of Fame" -- today I wrote to the city about his 50-year history of fraud [UPDATED]

UPDATE: Son of famed New Rochelle doctor asks for Walk of Fame reconsideration by Lisa Reyes, Local12 TV News (Westchester, NY), May 8, 2017:

The son of a New Rochelle doctor credited with creating the Heimlich maneuver says inducting his father into the New Rochelle Walk of Fame would be a mistake.

Dr. Henry Heimlich, part of the New Rochelle High School class of 1937, is world-famous for developing the anti-choking method that bears his name. This year, the city is honoring him by inducting him into its Walk of Fame.

Dr. Heimlich's son, Peter, sent a letter to the city urging officials to reconsider the designation.

"My father was involved most of his career promoting a bunch of crackpot medical ideas that resulted in the significant loss of life," he says.

Click here to direct download a copy of my letter.

Sunday, May 7, 2017

Part IV of "Drowning in Funworld" by Pamela Mills-Senn, final segment of the dramatic backstory of the landmark article that was our Rosetta Stone

Pamela Mills-Senn

Here's the fourth and final segment of Drowning in Funworld by Long Beach, CA, journalist Pamela Mills-Senn.

It's the dramatic backstory behind her landmark March 30, 2000 article that became the road map for much of the research by my wife Karen and me, work that resulted in hundreds of mainstream print and broadcast media reports.

Drowning in Funworld was first published 11 years ago this week by the now-defunct Cincinnati Beacon blog. It's my privilege to make it available again -- PMH

P.S. Big thanks to the United States Lifesaving Association and the organization's president, Chris Brewster, for posting Pamela's article on their website which is where Karen and I found it in 2002.

Water Rescue Sequence: The Controversial Role of the Heimlich Maneuver

Part I: Drowning in Funworld

Part II: The Tides of Research Rising

Part III: The Straw (Man) Argument

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Part IV: It's a Fun World After All

And so the writing began. The editor and I were concerned that - since it appeared Ellis & Associates had made a questionable decision in changing their drowning rescue protocol to the Heimlich maneuver - the article would be buried if we focused too much attention on them. We decided instead to concentrate on Heimlich and his research and hoped that interested parties (the waterparks, public pools, lakes, and amusement parks that had hired Ellis to provide lifeguard training) would put two and two together and ask some hard questions of the company. This is why you'll notice, if you look at the Funworld article, there is just one section related to Ellis, although they are mentioned towards the end of the piece as well.

In total, I wrote three drafts. The first was sent to the editor so he could weed down the word count, which approached 10,000 words. The second, based on his revisions, was then sent out to everyone that was interviewed or provided information (with the exception of Dr. Henry Heimlich). No one received the full article, just sections with their input except in those cases where I also asked sources to review my comments on research methodology, general drowning information, etc. Ellis received only his section and comments.

The third draft incorporated their comments, revisions and corrections and was sent to the editor. In turn, he sent the entire article out to Heimlich to give him a last chance to comment.

During my research, I would ask Heimlich to explain the discrepancies I was encountering.

For example, I asked him why he incorrectly extrapolated Dr. Linda Quan's data, why he didn't tell people this was a regional study? He responded that he did make people aware of its regional nature. But this was only occasionally true. He very often failed to mention the regional nature of this study and that consequently, data from this study was restricted in its applications. Unless you were educated in statistics, you would not appreciate the study's limits.

And when I asked him why he falsely stated that the lifeguards in Quan's study had been trained in CPR, he accused Quan of lying. He wrote:

Mouth-to-mouth was adopted for drowning in 1961 and was spread by the (American Red Cross) to lifeguards and the public very quickly. I find it hard to believe that 23 years later [Quan’s study covered 10 years beginning in 1974] they were not yet teaching CPR to lifeguards in Seattle. I’d like to see written proof from Quan. There is certainly no published statement in any of Quan's writing indicating that she improved outcomes by adding CPR to the lifeguard’s protocol for the first time [remember that I mentioned a later study conducted by Quan demonstrated this very thing]. How could she leave that out if it were possibly true? It sounds like something she thought of belatedly, after I quoted her findings of 42% mortality.

Interestingly - referring to Heimlich’s contention that by 1974 the majority of lifeguards were well aware of and well-trained in CPR - as I was researching the Funworld article I attended an industry trade show in Atlanta, which gave me the opportunity to sit in on an Ellis presentation about their aquatic services. At this presentation, they showed a video of a kid that had drowned in a public pool (the video was shot by a bystander). The trade show was in early 2000, I believe and the video was recent. The guards at that pool pulled the kid out and then did essentially nothing. They acted completely baffled, something that would never happen to Ellis-trained guards - or so the message was.

The presenter said these guards had received CPR training, although he wouldn’t say from whom. The point is that while Heimlich appears disbelieving that any guard could be untrained (or poorly-trained) in CPR, decades later, Ellis was willing to state this was the case.

This is how it went with Heimlich. He would start out by appearing to answer questions about his research, etc. but then in a weird sort of circular approach, sidestep the question either by referencing the very studies I was asking him about, or refer me back to his own chapters, writings and correspondence. It smacked of a sort of "because I say so," logic.

He would also refer to Ellis' adoption of his maneuver as evidence of its merit, not addressing the fact that this adoption was, in fact, based on his questionable science and misused data.

Throughout, he accused researchers of outright fraud, or of not understanding their own data. He also believed that the Institute of Medicine misinterpreted their findings and had made deliberate omissions around his work. At times, Heimlich almost sounded like a conspiracy theorist.

The third and final copy, the one sent to Heimlich after all the others had reviewed it, stood unchanged, in spite of his rebuttals. It was time to show the report in its entirety to Ellis.

I believe the editor showed it to Ellis and others who were attending a meeting of the International Association of Amusement Parks and Attractions safety committee. [Funworld is published by IAAPA.] I can't recall whether this committee was focused entirely on waterpark safety or also concerned itself with amusement parks.

The report's impact was immediate. The committee was upset and concerned that the news media, which routinely reads the trade publications of major industries, would get wind of the report. Although the article was to have run in the magazine, and later when it grew longer, to be included with the magazine as a supplemental report, ultimately it was kept out of the publication altogether. Instead, a month or so later, it was mailed out to IAAPA members as a "Special Report," effectively keeping it out of the public eye — although whether this, or costs, was the motivating factor, only the publisher knows. [Editor's note: The privately-distributed Funworld article was dated March 30, 2000. A few months later, the Los Angeles Times reported the story.]

One drowning authority I relied heavily on during my research was Jerome Modell M.D., at the time a professor in the Department of Anesthesiology at the University of Florida's College of Medicine. As I said in the Funworld article, Modell's work in drowning is internationally known and referenced. As of that writing, he had also acted as an expert witness in drowning litigation on approximately 150 occasions.

When Modell heard that the article was not going to be published in the magazine, he fired off a letter to John Graff, the president and CEO of IAAPA. In it he said:

For you now to deny the printing of this material indicates to me that…the report did not result in a manuscript that fit your personal prejudices. I can tell you that as a scientist, on many occasions, experiments that I and my colleagues have performed have produced results that did not meet our pretesting biases, but in the end, resulted in an even more significant contribution that had our predetermined biases been true.

For the above reasons, I believe that your censorship of this article was inappropriate; some have even expressed the opinion to me that external pressure, or perhaps a vested interest in a different outcome, may have influenced your judgment in this matter. I personally chose not to believe this, but I urge you, in the interest of safety for all of us who are interested in water sports, to publish this article in Funworld magazine at the earliest possible date.

Graff was unmoved.

Within days of receiving the article, Ellis quietly changed their protocol back to CPR, claiming they had decided to do so partly because of the Institute of Medicine's findings and decision not to endorse the maneuver for drowning or revisit the issue. (The first IOM committee reviewed the issue in 1991 and the second IOM committed reviewed this again in 1994. This was not a recent decision and Ellis should have been well aware of it).

Another reason Ellis gave was their submersion data. They started collecting data on the maneuver in 1995, when they changed their protocol. They also had older data, going back to 1985 when Ellis-trained guards were still responding with CPR. They had been touting their data as demonstrating the maneuver was superior to CPR, but the problem was, as Ellis representative Larry Newell admitted, the two sets of data were not comparable, so no meaningful comparison between the two protocols was possible. In fact, it was impossible.

But they had to have known this before receiving the article.

Funworld's editor was fired, forced to resign, however you want to spin it, because of this article and because he backed it. All along, I had been thinking only of how I might be impacted. I had no idea the heat he was taking and had been taking for months. And yet, when he had the chance to kill the article, he didn't take it. I can’t tell you how much I admired him and still do.

In Part Three I mentioned the Save A Life Foundation and that they were the only organization outside of Ellis to endorse and teach the maneuver for drowning. At the time, Heimlich sat on that organization's medical advisory board, as did CPR developer Dr. Peter Safar. The medical director then was Stanley Zydlo, M.D.

He told me during an interview, that they initially advised folks to use CPR, but decided to switch to the maneuver based on the 42% fatality rate from Quan's study (and supplied to him by Heimlich) and also on CPR’s "median mortality rate of 40%" another figure supplied by Heimlich. Zydlo contrasted this to Ellis' stated mortality rate, attributed to the maneuver protocol, of just 3% and decided this was proof enough the maneuver worked far better than CPR.

But, said those whom I interviewed for this article, Ellis' low mortality rate is more likely the result of the very short submersion times (remember, Ellis says their average submersion time is 29 seconds) rather than the maneuver.

As far as I know, although I haven’t investigated, the Save A Life Foundation is still recommending the maneuver as a first response to drowning/near-drowning, in spite of receiving a copy of the article and in spite of Ellis’ reversal. [Editor's note: In the wake of dozens of media exposes alleging fraud, the Save A Life Foundation went out of business in 2009 and the organization's founder/president Carol J. Spizzirri is a defendant in a wide-ranging federal civil rights lawsuit brought by a former SALF employee.]

After fulfilling a contract for another article, established when the editor was still in place, I never wrote for Funworld again. The editor found another job, and we kept in touch. We felt like we were the only ones in the world, except for a handful of others, who knew what we knew and we had weathered it together. But the knowledge of what people are willing to do to advance their agendas remains with you and changes you, and it changed me.

I remember the mixed feelings I had when Ellis reversed their decision. On the one hand, it confirmed that my research had uncovered real problems. Otherwise, I believe Jeff Ellis would have stood his ground and presented evidence favorable to his decision. He had every opportunity to do that.

But the quick reversal made it appear, in my mind anyway, that these problems were known all along, and this was troubling. Because it seemed to me that what had really taken place in the waterparks were the very human studies experiments that the IOM had said should not be approved. And it seemed like admission prices were high enough without tossing this into the mix.

We'd like to think we can count on the gatekeepers, like Ellis, to protect us from people like Dr. Heimlich, that would use us to their own purposes. I guess what I learned from this experience is that the gatekeepers need watching too.

Postscript: Several years after the publishing of the article, reports of Dr. Heimlich's "malariotherapy" experiments began appearing in the Los Angeles Times and other news outlets. Around that time, I was contacted by Peter Heimlich, Dr. Heimlich's youngest son. Peter and his wife Karen have worked tirelessly to expose problems surrounding Dr. Heimlich's research and claims.

Suddenly, the editor and I were not so alone.

Saturday, May 6, 2017

Part III of "Drowning in Funworld" by Pamela Mills-Senn, the dramatic backstory of the landmark article that was our Rosetta Stone

Imagine you're a freelance journalist whose writing assignment for a trade magazine produced a thoroughly-researched, bulletproof article that exposed a world-famous doctor as a dangerous nut and revealed a major industry player to have been recklessly putting the public at risk for the previous five years.

In fact, your expose was so explosive that the magazine refused to print it, but instead circulated it privately to industry members to keep the mess under control.

For good measure, the magazine even fired your editor for refusing to spike your article.

Presumably you'd feel frustrated.

Now imagine that two years later, in an unlikely twist of fate, the famous doctor's son and daughter-in-law -- that would be me and my wife Karen -- stumble upon your article tucked away on the website of a nonprofit organization.

Using your article as a road map, they uncovered a wide-ranging array of frauds which the son shared with reporters, resulting in hundreds of mainstream print and broadcast exposes over the next decade.

Those stories revealed the famous doctor -- my father, of course -- to be a world-class medical maniac, exposed a variety of his, um, problematic associates (here, here, and here), and made the industry player and the cover-up by the trade magazine look even worse.

Presumably you'd feel vindicated.

That's the true story of this article by Long Beach, California journalist Pamela Mills-Senn:

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Eleven years ago this week, the Cincinnati Beacon blog published the four-part Drowning in Funworld, Mills-Senn's dramatic journalism backstory about her landmark article.

In 2011 the Beacon gave up the ghost so I'm proud to have the opportunity to make it available again.

Before proceeding, I recommend that you read the following in this order:

Water Rescue Sequence: The Controversial Role of the Heimlich Maneuver

Part I: Drowning in Funworld

Part II: The Tides of Research Rising

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Part III, The Straw (Man) Argument

When drowning expert Dr. Linda Quan returned my call, she confirmed that Dr. Henry Heimlich's extrapolation of her data was incorrect. Then she dropped another bombshell.

Remember that Heimlich claimed the children in Quan's study had been given CPR by Red Cross trained lifeguards? He takes this a step further in his chapter stating that, "Lifeguards were not permitted (italics mine) to use the Heimlich maneuver, only CPR."

All of this was patently untrue, said Quan.

She told me that the death rate for children pulled from the pools by lifeguards in her study was 42%. But she went on to tell me that these were lifeguards in the loosest sense of the word. They sold tickets and hot dogs, they manned the locker rooms, and contrary to Heimlich's contention, they had received zero CPR training by any agency.

(Later, when I received her complete study, I saw where she stated, "[CPR] training and competency is not required for lifeguarding, but it should be." In this same study Quan also said that the high mortality rate, "Reflects on the ability of the lifeguard to recognize, rescue, and resuscitate the drowning child.")

These were the contributing factors behind the high mortality rate and why she advised that lifeguards receive CPR training, Quan told me during the first of what turned out to be many calls (and even more emails). And in fact, Quan continued, a later study she conducted demonstrated that an increase in CPR-trained guards was among the factors associated with a decrease in the number of drownings and near-drownings in this area.

(It's also interesting to note that during the period of time covered by Quan's study, the maneuver for drowning was not even an issue for rescue personnel so Heimlich's assertion that guards were not permitted to use the maneuver appears to be a misstatement of the situation.)

I was floored.

"He does this all the time," she fumed, referring to Heimlich. She had told him and told him and insisted that he stop misrepresenting her work, but he continued to do so.

(OK, here's where I start nutshelling, just to spare you word count. If you would like to see my original article - I warn you its close to 8,000 words - click here.)

Mary Fran Hazinski of the American Heart Association started sending me drowning research studies, as well as documents from the National Academy of Science (NAS) and the Institute of Medicine (IOM). Quan provided information as did a source at the Red Cross. And I continued to ask Heimlich for sources favorable to his cause, and to pester Ellis & Associates president Jeff Ellis and one of his main guys at the time, Larry Newell, for information not only about how people drown, but why they decided to switch from using CPR to the maneuver.

In the end, between the materials everyone sent and the resultant interviews, correspondences, journal articles, emails, etc., I ended up with five well-stuffed file folders of information.

Until I started this project, I really hadn't given much thought to how people drown. I just figured it wouldn't be one of the ways I'd want to go. But I did think that when people drowned, their lungs completely filled up with water, and that this was in fact the very definition of drowning.

And this is Heimlich's perspective. He says that in almost 90% of all submersions the victim inhales enough water to "fill the lungs." He says its impossible to ventilate lungs that are filled with water. He also contends that the maneuver "clears all the water from the lungs," even from the alveoli (microscopic air sacs within the lungs).

Heimlich supports his assertions in a variety of ways - most typically, I discovered, through creative interpretation of other researcher's work - but also through his own efforts. For example, to demonstrate the difficulty of ventilating through fluid, he uses a straw, inserted into a container of water. Once, inserted, water fills the straw to the same level that it fills the container.

Placing a finger over the exposed end of the straw, he pulls it from the container. Heimlich explains that the water remains in the straw because of atmospheric pressure and surface tension. Blowing into the open end of the straw, through the water causes only a slight movement (the way mouth-to-mouth given to someone with water in their airway causes the chest to rise, he says) but no air reaches the finger. Heimlich says the straw mimics the lungs and demonstrated that air cannot pass through water.

I cannot tell you how nuts that illustration made Quan, Hazinski and others that I spoke with.

OK, here was my problem and also my motivation for all the phone calls I made, the countless papers/abstracts I read (with titles like "No Improvement In Pulmonary Status by Gravity Drainage or Abdominal Thrusts After Sea Water Near Drowning." A study conducted by CPR developer Dr. Peter Safar and Nicholas Bircher, both drowning experts) the mountains of emails I sent, the people - drowning researchers/experts, doctors, lifeguards, Coast Guard personnel, EMTs - that I tracked down, not to mention the sleep I lost for six months.

Ellis & Associates

Their company had switched to the maneuver and yet no matter whom I contacted, and I started out by calling those whose research Heimlich had used to make his case, they all said the same thing - Heimlich had misinterpreted their research, some said this was deliberate, and that he was wrong.

Lungs do not fill up with water, they said. In most cases, because of something called a laryngospasm (this happens with a foreign object like water or food passes the vocal cords causing the larynx to spasm and close off. Example: when you take a drink and it goes down the wrong pipe and you cant breath. This is what happens when a person is drowning) there is hardly any water in the lungs at all.

Plus, said the experts I interviewed, fresh water in the lungs is rapidly absorbed, creating an inability to recover any amount of water through drainage, suction (or the maneuver). What is left in the lungs is pulmonary edema fluid, which is very frothy and not easily expelled - not aspirated water that can be removed by the maneuver. Furthermore, they said, it is possible to ventilate through water. And I found no one that agreed with Heimlich that the maneuver could remove water from the lungs. The general consensus was, and still is, that if the maneuver does result in fluid being expelled, it is coming from the stomach.

The focus needs to be on ventilating people as quickly as possible, they said, something that administering the maneuver (until no more fluid is expelled, as Heimlich advises) could seriously delay, resulting in brain damage or death.

I asked Heimlich and also his associate Edward Patrick, M.D. who had worked with Heimlich to develop the maneuver, for more sources supportive of the maneuver. Heimlich provided a list that included several people who had been resuscitated with the maneuver. I didn't call them because I wasn't interested in talking with those untrained in drowning.

Another contact was, at that time, chairman of the National Swimming Pool Foundation, and I did interview him. As it turned out, he had no medical nor guard training; he just did research into the physical aspects of pool safety, such as building materials used, design, etc. Heimlich put me in touch with him because that organization also trained pool operators and Heimlich had approached him about endorsing the maneuver instead of CPR.

I was unable to reach either the fire commissioner (he would not return calls) or the lifeguard (he had moved) on Heimlich's list.

He also suggested that I call Carol Spizzirri, president of the Save A Life Foundation, based in Schiller Park, Ill. The foundation's focus is to encourage bystander involvement in emergency situations and on public education. This was the one organization, other than Ellis, that endorsed responding with the maneuver first for drowning resuscitation. (More on this in part four.)

Another source Heimlich put me in touch with was a retired surgeon and former chief surgeon of the Washington D.C. fire and police department, Victor Esch. According to Esch and Heimlich, Esch was the first to use the maneuver to revive a near-drowning victim. Esch told me he happened upon an unconscious swimmer being pulled out of the water by a guard.

"I don't know what this guy ate before he went swimming but vomit and food was everywhere. There was just no way you could have done CPR on this person," he told me.

Fair enough, and using the maneuver to clear the airway makes sense in this situation. In fact, few would probably argue against it. The only problem is, when Heimlich tells the story he leaves out the vomity details, preferring instead to say that after being given the maneuver, clear fluid was expelled, this fluid presumably being water and presumably coming from the lungs (according to Heimlich).

This is a significant discrepancy, and I asked Esch about this.

"I don't know why Henry keeps saying that," I recall Esch telling me. "I keep telling him not to." [Editors note: Neither Esch nor my father revealed that they had a pre-existing relationship dating from decades before the drowning rescue Esch claimed to have performed.]

There's more. Patrick suggested that I call a researcher in Canada who was working on a device that would administer the maneuver, rather than a person having to do it. I didn't see how this figured into anything, but I called anyway. During our conversation (the details are not important for our purposes) he mentioned that his research indicated the number of choking deaths had stayed pretty constant since around 1955 to present (we spoke in 2000) meaning that there had been little decline in the numbers of folks dying from choking.

But, I asked, have you taken population increases into account? If you have, then the percent of choking deaths has certainly declined, which would therefore indicate that overall, fewer folks are dying this way.

Well no he hadn't, he told me. I guess I should have done that, he admitted.

This was the caliber of researcher Patrick put me in touch with. [Editor's note: A 2004 Cleveland newsweekly cover story and a subsequent lawsuit revealed that for 30 years, Patrick had practiced medicine based a bogus credentials supplied by my father.]

At the time, Heimlich was trotting around a young lifeguard to various presentations who had rescued two boys from a wave pool, resuscitating them with the maneuver. I called Nathan, who was 19 at the time of the incident. He was 21 when we spoke, in college and no longer guarding. True, he did use the maneuver to revive these kids, but when it happened, he was a first-time guard, he had never made a previous rescue, had never used CPR (he was initially trained in CPR but then Ellis switched their protocol) so therefore had nothing by which to compare. And he was on those kids in an instant when they got into trouble.

Here's what happened. The youngsters had been seeing who could hold their breath the longest under water. Apparently, the competitive spirit got the better of them and they passed out. Nathan had been watching them from his guard tower and got to them immediately.

Now many drowning experts say that in very brief submersions and since this was an Ellis-trained guard, and Ellis says the average submersion time for victims rescued by Ellis guards is around 29 seconds, its safe to assume the submersion time was short - the victims would probably not have inhaled any water and certainly not have experienced cardiac arrest. Some told me a slap across the face could revive people in this situation.

So, as nice as Nathan was, he hardly qualified as an expert spokesperson for the maneuver. I wondered, couldn't Heimlich come up with anyone better?

I was starting to panic. The situation for Ellis & Associates was looking dire. No matter where I searched, medical support for the maneuver was hugely absent. Even more worrisome, if I could find all this out, surely Ellis could have. And if he did know this, why did he move forward with the maneuver? And if he didn't know this, why didn't he? Wasn't he obligated to his clients to exercise responsible due diligence?

It wasn't making any sense.

About three months into my research, I called the editor, whom I had been keeping informed throughout. It wasn't looking good for Ellis, I said. I haven't been able to find any medical justification for what they've done.

I was worried this would ruin their business, I said. Do you want me to stop? Do you want to let this go? He didn't. "We have to, we know too much not to," I recall him saying.

So that was that, and the die was cast. And so I kept trying and trying to find a way to understand the decision Ellis had made. But it did nothing but get worse.

I asked Heimlich to supply me with the same materials he sent to Ellis, and I asked Ellis the same question. I was hoping this would turn up something different, something that would truly support the Ellis protocol.

Nothing.

I asked Ellis who was on their medical review board, the one responsible for making the decision. I asked Heimlich this also. It was comprised of folks that had PhDs in areas like engineering, mathematics and physical education (although they all had extensive background in water safety and some had worked with the Red Cross at one time, and at least one, other than Ellis, had an aquatic safety consulting company).

There was one M.D on the board; an emergency room doc that worked out of Rockford Memorial Hospital in Illinois. He was initially agreeable to an interview until I emailed him a list of questions about his experience, how many drowning victims he had worked with, his concerns around CPR, why the maneuver was superior, etc. Upon receiving that list he refused comment.

But it seemed to me that a medical decision such as switching from CPR to the maneuver would have, or should have, required that more than one person on the board be a physician, and that this person should have extensive experience in drowning resuscitation.

All along I had been corresponding with Newell, who was initially a very patient and helpful Ellis source. But as my questions became more focused on data and details, I guess as I was moving through the research process and learning more, he became less agreeable. And I grew more confused.

In one email I asked him that if it couldn't be assumed that CPR was responsible for reviving people, because their condition at the time was largely unknown (an issue discussed in an earlier correspondence) then by the same token, it could not be assumed that the maneuver was responsible for reviving people. He responded in all caps.

THIS IS PRECISELY THE ISSUE HERE. NO ONE KNOWS FOR SURE WHETHER CPR, RESCUE BREATHING, HEIMLICH OR ANY COMBINATION OF THESE WORKS BEST.

So, Ellis was experimenting?

And in an earlier email, when I asked Newell if he could provide any well-known sources who could support the maneuver (telling him that I had a list as long as my arm of those who opposed it), he said he couldn't.

"While there are some EMS system personnel who have concurred with Heimlich, he is actually a one-man show. There are no medical bodies I am aware of that endorse his position, only the folks you already know."

I also ran across a copy of an article that appeared in an issue of Emergency Medicine News. I think this was a December 1993 or 1995 issue, I cant be sure because the date is blurred.

But in this article, entitled, "Debate Raging Over use of Heimlich in Drowning," Newell, who has a PhD and was at the time manager for program development for the Red Cross National Healthcare and Education, was clearly opposed to the use of the maneuver for drowning, saying that, "Dr. Heimlich knows absolutely nothing about our materials and our programs," and that, "The Red Cross position is clear; We teach the consensus of opinion thats stood the scrutiny of the peer review process."

And yet now, just a few years later, he was aligned with Ellis and Heimlich, the latter of whom advises EMTs, lifeguards and others to ignore peer reviewed lifesaving processes.

I decided not to ask what had caused this change of heart; Newell wasn't really my focus and besides, he had grown too testy, telling me that he was concerned about where the article stood, demanding to see it in its entirety prior to publication, and telling me that I no longer had access to any Ellis staff but him. The ranks had closed.

The article began to take a personal toll. I was constantly second-guessing myself. I became compulsive in my efforts to try and find support for the maneuver. Rather than working to prove Heimlich wrong, I was determined to find Ellis right. The implications seemed too fraught otherwise.

And all the while, in talking with doctors who had dealings with Heimlich throughout the years, I was warned. I would be sued. Heimlich had tried to derail the careers of many of those who had opposed him, I was told. There were implied physical threats (one Ellis cohort told me, and I remember his exact words, "If you're thinking about going up against Ellis, you're going to have people breaking down your door.").

I asked my editor what kind of legal protection I could expect from the magazine.

"Not much," he said.

I worried constantly that I would be sued, and wondered if this was fair to my (then) husband. Defending a lawsuit was simply beyond our financial means. My husband was sick of it all; he just wanted it over with. Our friends starting looking at me with all the fondness reserved for insurance salesmen and IRS auditors. "Can't you talk about anything else," they would fairly plead.

I remember the very last call I made before deciding it was time to wrap it up and start writing. Heimlich had faxed me an article from the Cincinnati Enquirer about a recent drowning. One of the detectives in the article was quoted as saying the victims lungs were filled with water - which is why Heimlich wanted me to see this.

I tracked down the detective in the article and read back that quote.

"I never said that," he said. "There wasn't much water in the lungs."

In the end, I decided that I could research this forever and probably still never be comfortable. The editor and I decided that our focus needed to be on the materials Ellis used to make the decision, working from what they worked with, not trying to break any new ground. Were there unanswered questions that the scientific and medical communities needed to address about drowning? Yes, but that wasn't our job, he said. Our concern was the waterparks and what they were doing now.

And here's one thing I kept coming back to, and still do; a report generated by the Institute of Medicine, who had been asked to (twice) review the drowning application of the Heimlich maneuver. After extensive review they found there was no reason to revise Emergency Cardiovascular Care guidelines in favor of the maneuver. One of the objections they raised about Heimlich's work was the lack of valid data demonstrating the maneuvers efficacy in near-drowning cases, although they acknowledged how difficult collecting this data would be. They said, "It is hard to imagine a research methodology for such a study that would or should be approved by a human studies committee."

So, what in the hell was going on in the waterparks? I wondered. And I still do.

Part IV: It's a Fun World After All