Tuesday, May 16, 2006
Posted by The Dean of Cincinnati
 In this exclusive series, freelance writer Pamela Mills-Senn tells the story behind some landmark investigative journalism she published regarding Cincinnati’s infamous Dr. Henry Heimlich. In this final installment, she discusses the effects of her research and writing, both personally and on the rescue industry.
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Read Part Three: The Straw (Man) Argument
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And so the writing began. The editor and I were concerned that—since it appeared Ellis had made a questionable decision in changing their protocol to the 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 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. He in turn, 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 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 ARC 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 tradeshow 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 tradeshow 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 IOM 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 IAAPA safety committee. 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 pubs 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 pub 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.
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, 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 IOM’s findings and decision not to endorse the maneuver for drowning or revisit the issue. (Note: 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 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.
The 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.
I mentioned in Part Three 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 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.
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 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 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 began appearing in the LA Times newspaper. Around that same 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. But this is another story.
Editor’s postscript: Pamela Mills-Senn’s article and its influence on Ellis & Associates’ reversal on the Heimlich maneuver for drowning rescue was reported in a May 30, 2000 article in the Los Angeles Times. Ellis’s representative, Larry Newell PhD, issued a press release, available here along with statements by the Red Cross and others.
As previously reported here, the American Heart Association’s drowning rescue guidelines continue to unequivocally warn against the use of the Heimlich maneuver. Nevertheless, according to Dr. Henry Heimlich, the maneuver for drowning continues to be taught by Save-a-Life-Foundation, which is affiliated with the Department of Homeland Security. (Dr. Heimlich is a founding board member of the organization.) As we’ve also reported, Deaconess Associations, owner of the Heimlich Institute, continues to teach and promote the maneuver for drowning—and they also refuse to answer questions.
Dr. Heimlich has stated, “The Ellis lifeguard study from 1995-1999 remains the largest human study ever conducted regarding the effectiveness of the Heimlich Maneuver for drowning.” It’s hard not to reach the conclusion that swimmers at Ellis’ client pools were unwitting participants in an experiment on the American public to test an unproven first aid rescue method, one which had been universally repudiated by medical experts for the previous decade.
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Read Part Three: The Straw (Man) Argument
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