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Updated June 12, 2008

 

Where did the idea that backblows are dangerous come from?

by Peter M. Heimlich

SYNOPSIS: From this June 9, 2008 news report:

(Former Presidential candidate Mike Huckabee) told Fox News on Monday he didn't think twice when he stepped in and gave (Robert) Pittenger the "Heimlich Maneuver" - pressure on the abdomen to dislodge the food. "I just happened to look up and I saw somebody patting on the back...I knew that the worst thing you can do is pat someone on the back if they're choking," Huckabee said, noting that he had taken emergency medical training when he was younger.

Except for between 1986-2005, backblows were the primary choking response taught by US first aid organizations. Currently, both the American Red Cross (ARC) and the American Heart Association (ARC) approve the use of backblows as an acceptable treatment response. So why do former Governor Huckabee and many others believe that backblows are dangerous?

Facts prove that with no medical evidence to support his claim, my father Dr. Henry Heimlich introduced the idea in 1975. For the next decade, he used the media to aggressively circulate the idea in an effort to eliminate backblows from the first aid guidelines of the AHA and ARC via an emotion-driven campaign he called "backblows are deathblows."

In 1982, the journal Pediatrics published a research study published by three Yale-affiliated physicians which affirmed my father's claims. In July 1985, my father and the lead author of the study presented it at an AHA national conference. A few months later, then-US Surgeon General C. Everett Koop issued a widely-reported public statement that all choking rescue methods other than the Heimlich maneuver, including backblows and chest thrusts, were "hazardous, even lethal." In his statement, Koop recommended that the AHA and ARC remove these methods from their choking rescue treatment recommendations. A short time later, the AHA and ARC followed his advice.

Roger White MD chaired the 1985 American Heart Association (AHA) committee which recommended that backblows be removed from AHA guidelines. From the "Panel recommendations" section of Foreign Body Airway Obstruction: Considerations in 1985 by Dr. White, published in the December 1986 issue of Circulation, the AHA journal:

The most persuasive data presented for review were those of Day and associates cited above.

20 years later, our research turned up two facts.

1. My father clandestinely funded the Yale study. Neither he nor the authors of the study shared that information with the AHA or ARC. After first being informed of this fact, Dr. White wrote:

There was never any evidence here. Heimlich overpowered science all along the way with his slick tactics and intimidation, and everyone, including us at the AHA caved in. (Cincinnati Magazine, April 2007)

The New Haven Register, the Columbus Dispatch, the Daily News Journal (TN), the Auburn NY Citizen, and Cincinnati Magazine have reported stories about my father's clandestine funding of the Yale study

2. Re: US Surgeon General Koop, as I told NY Sun columnist Lenore Skenazy:

"Koop was an old friend of my father's, and he did it as a buddy favor." (source)

More on the tainted Yale study below. More on Koop's "buddy favor" here.

 


A research study which was influential in changing national choking rescue protocols in favor of the Heimlich maneuver was funded by my father's own foundation. He and the author of the study, the late Richard L. Day MD, did not diclose this fact to the 1985 American Heart Association committee at which the study was presented. They also neglected to reveal to the committee that they were personal friends who had been in close touch before, during, and after the study was completed.

The July 1982 issue of "Pediatrics" contained an article entitled, Choking: The Heimlich Abdominal Thrust vs. Backblows: An Approach to Measurement of Inertial and Aerodynamic Forces by Richard L. Day, MD, Edmund S. Crelin, Phd, and Arthur B. DuBois, MD. (Day and Crelin are dead, but Dr. DuBois still works at Yale University.) This paper described a research study showing that backblows force objects deeper into the throats of choking victims, a study which Heimlich has described as scientific proof of the superiority of the Heimlich maneuver over backblows, which he has repeatedly characterized as "deathblows."

Dr. Day - then a 79 year old retired pediatrician and Yale emeritus professor - and my father were both members of the July 1985 American Heart Association Committee on Management of Foreign-Body Airway Obstruction, at which the Day study was presented. (This was the same national AHA Conference at which the Heimlich maneuver for near-drowning rescue was considered, but by a different committee.) This followed many years of contention regarding backblows, much of it the result of an aggressive public campaign conducted by Heimlich & Patrick against the National Academy of Sciences, the AHA, and the American Red Cross, a campaign which included accusing the agencies of participating in a conspiracy to cover-up scientific evidence.

The 1985 AHA committee decided that the Heimlich maneuver should be the sole choking rescue method taught in national rescue protocols, partly relying on the Day study. From the published AHA Standards and Guidelines from the conference:

Data were presented at the conference that suggest that, as a single method, back blows may not be as effective as the Heimlich maneuver in adults. (The Day study in Pediatrics is cited here.) Because of these data, and in an effort to simplify training, the Heimlich maneuver is the only method recommended at this time. More research and investigation are necessary.

Roger White MD chaired the 1985 American Heart Association (AHA) committee which recommended that backblows be removed from AHA guidelines. From the "Panel recommendations" section of Foreign Body Airway Obstruction: Considerations in 1985 by Dr. White, published in the December 1986 issue of Circulation, the AHA journal:

The most persuasive data presented for review were those of Day and associates cited above.

The Day study also influenced the American Medical Association's Council on Scientific Affairs to recommend changing national rescue protocol for choking victims. From a December 1986 letter to JAMA by Dr. John H. Moxley III, the chairman of the council:

The Heimlich maneuver was recommended as the preferred technique for the removal of a foreign body from an obstructed airway in both adults and children...The preference for the Heimlich maneuver in most cases resulted from a reconsideration of the data by Day et al, who concluded that, theoretically, back blows can displace displace supraglottic foreign bodies downward into the throat or larynx...."

The end of Day's 1982 article in Pediatrics includes this funding acknowledgment:

This work was supported in part by The Dysphagia Foundation, Inc. Cincinnati, the Crippled Children's Aid Society, New Haven, CT, and National Institutes of Health grant HL 23959.

Neither my father nor Day informed the 1985 AHA committee that the Dysphagia Foundation was my father's own foundation, used to fund his projects since its inception in 1961. (Corporate documents list the directors as Heimlich, his wife, Paul Winchell (a television ventriloquist and personal friend of Dr. Heimlich), an attorney, and Dr. Heimlich's father.)

The Dysphagia Foundation became The Heimlich Institute in 1982, the same year Pedriatrics published the Day study.

A June 7, 1982 letter from my father to Dr. Day acknowledges Heimlich's clandestine funding of the Day study:

We are certain that your funds were well spent and appreciate the opportunity to support your good work. No receipt is necessary.

No receipt indeed.

After the 1985 AHA Conference, Dr. Day's co-author Dr. Arthur DuBois wrote this whimsical pseudo press release, Dr. Dick Day Deals Death-blow to Back Blows which gaily observed:

Defying giants of the American Heart Association's prestigious Committee on Emergency Treatment of Airway Obstruction, scientific gun-slinger Day took on the Committee in a medical shoot-out that included other notables in the field of resuscitation. At the end, the Committee, eating its own words, almost choked on its previous recommendations of back blows and had to be given a verbal Heimlich maneuver by Dr. Heimlich himself who, luckily, was on hand for just that purpose.

Challenged by proponents of 'back-slaps, or chest thrusts', Heimlich swept aside such alternatives to his life-saving procedure. Heimlich said that his procedure was in use in Japan and China, and its efficacy had never been questioned....But it was Day, wearing the white hat, who provided the scientific measurements that destroyed the back blow and dismayed its proponents, who by then were wearing the black hats.

Medical progress, said Day, depends on scientific experiments and statistical validity of properly collected information, not anecdotes. He offered the results of scientific experiments conducted in the John B. Pierce Foundation Laboratory in New Haven. Day and DuBois found that the compression of air in the lungs, measured using a body plethysmograph method, lasted for only 1/100 second after a back blow, whereas the compression of air from a Heimlich maneuver was greater, and much longer in duration. The Pierce Foundation group also showed that acceleration of the foreign body from a back blow was in the wrong direction according to Newtonian forces, and therefore theoretically could wedge a foreign body in the larynx.

...The Dallas medical shoot-out resulted in a victory for the white hats, Drs. Day, Heimlich, and (Dr. Edward A.) Patrick, supported by an emotional appeal by Dr. (Trevor) Hughes for adoption of the Heimlich as a standard training procedure for housewives. The black hats retreated to their Committee room to lick their wounds and rewrite their recommendations for emergency treatment of choking.

After first being informed of that my father secretly funded the Yale study, Roger White MD, chairman of the 1985 American Heart Association committee (and presumably considered one of "the black hats" by Dr. DuBois), wrote:

There was never any evidence here. Heimlich overpowered science all along the way with his slick tactics and intimidation, and everyone, including us at the AHA caved in. (Cincinnati Magazine, April 2007)

From Red Cross Reverses Policy on Choking Aid by Abram Katz, New Haven Register, October 23, 2006:

For years, the American Red Cross recommended the abdominal thrust, a posterior hug with a fist just below the sternum, popularly known as the Heimlich maneuver. This stand was supported in part by a 24-year-old study at Yale University, which appears to have been assisted by the object of the study, Dr. Henry J. Heimlich himself. While critics of Heimlich cast doubt on the Yale study, Yale is the only institution that has conducted a follow-up investigation, and apparently no other institution has attempted to compare the effectiveness of the Heimlich maneuver to back blows

...The connection between Heimlich and the Yale scientists appears to pose at least the appearance of a conflict of interest. But (Dr. Arthur) DuBois, the only surviving author and professor of epidemiology emeritus at the Yale University Medical School, said Heimlich was not involved with the study...."Our lab work still stands up," he said.

Heimlich did not answer questions about the new Red Cross recommendations when he was contacted in his home in Cincinnati. He also did not return phone calls.

 

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