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.

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.


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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:

source

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:


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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

Friday, May 5, 2017

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

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Yesterday I published Part I of Drowning in Funworld, a dramatic four-part article by Pamela Mills-Senn that first saw the light 11 years ago this week on the now-defunct Cincinnati Beacon blog.

In it she relates how a routine writing assignment for an amusement park trade magazine unexpectedly turned into a white-knuckle ride on a journalistic roller coaster.

The result?

A landmark March 30, 2000 article that exposed a reckless, unethical campaign by my father and the country's largest private lifeguard training company, Ellis & Associates.

Since 1995, Ellis-trained lifeguards at scores of major waterparks around the country were being taught to resuscitate drowning victims using the Heimlich maneuver (abdominal thrusts).

Leading medical organizations including the Institute of Medicine had already declared the treatment to be useless and potentially deadly because it wastes precious rescue time and might cause vomiting leading to aspiration.

In other words, Ellis lifeguards were apparently using swimmers at their client pools as human guinea pigs to test an experimental medical treatment.

(Why company founder/president Jeff Ellis ever thought this was a good idea may be a question he now asks himself.) 

The fearless, thorough reporting by Mills-Senn (who lives in Long Beach, CA) and her editor Mike Moran exposed this madness and revealed my father to be a scoundrel and a humbug who didn't even understand the basic physiology of drowning.

And her article was effective.

Soon after it was published, per a May 30, 2000 Los Angeles Times article, Ellis dropped the "Heimlich for drowning" protocol.   

A couple of years later when my wife Karen and I found her article posted on the website of the United States Lifesaving Association, little did we know that our lives would never be the same.

It became the Rosetta Stone for our research that resulted in hundreds of mainstream print and broadcast media reports which exposed my father's disgraceful history; his bizarre 30-year colleague, Dr. Edward A. Patrick; the $9 million Save-A-Life Foundation scandal, and more.

And Pamela became a valued friend.

Before proceeding, I recommend that you first read her article that set us on our course, Water Rescue Sequence: The Controversial Role of the Heimlich Maneuver, and then Part I of Drowning in Funworld.  

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Part II: The Tides of Research Rising

I didn't receive duplicate research papers from both sides in every case. One such instance involved a study published in a June 1989 issue of Pediatrics that was conducted by Linda Quan, M.D., internationally known for her work in pediatric drowning. Dr. Henry Heimlich had sent me just the first couple of pages of her study; (the American Heart Association's Mary Fran) Hazinski had not included this in her packet of materials.

Quan's research was important to Heimlich because it was from this study (entitled "Ten-Year Study of Pediatric Drownings and Near-Drownings in King County, Washington: Lessons in Injury Prevention") that he derived a shocking figure that the use of CPR to resuscitate children pulled from public pools resulted in a 42% fatality rate. Heimlich further stated in his own materials (in which this figure was used over and over again to demonstrate CPRs ineffectiveness for all populations) that the children in Quan's study had been given CPR by Red Cross-trained guards.

It was Quan's study I held in my hands that early morning and it was this study that contained the red flag that had been flapping - completely overlooked - in my face all this time.

But before going further, here's a little background on me.

I've earned two Bachelor's degrees, one in psychology and one in anthropology. I completed two years of Master's level coursework in anthropology, with a focus on medical anthropology and how culture affects compliance. I opted out of the thesis and instead, wound up at a small magazine publishing company doing research and marketing, an association that lasted about 14 years before I struck out on my own as a freelancer.

Both my majors were heavily research oriented. I spent six years as an undergrad learning the difference between well-constructed research and research that was not up to standard. Throughout the eight years I was at the university I took a variety of classes on research methodology, statistics and the like. I know how to tell good from bad, valid assumptions from invalid and so on, although I'm not an expert - certainly not at the level of say, someone with a PhD or an M.D. behind his or her name.

Looking at the Heimlich-supplied partial copy of Quan's study, and then at his materials where he quotes the 42% death rate associated with the use of CPR, I realized that he had extrapolated from a small, self-contained regional population and translated the data derived from this population as being true across the board for everyone. Nowhere in the papers that he provided to me at that time, nor in the copies of his correspondence that he sent to various folks trying to win support for using the maneuver for drowning resuscitation, did he mention this was a regional study and therefore valid only for that population.

I was stunned that he would commit such a rank error, one that any beginning statistics or research student would be rapped across the knuckles for.

Here's why you can't do what he did. Say for example, you wanted to do a study on the average amount of time that people, unprotected by any sunscreen, could remain in the sun before burning. Now, say you included only redheads in this study, or only African Americans. How valid do you think it would be to extrapolate from these groups to the entire population at large? (Not to mention you would have to take varying levels of pigmentation into account along with a ton of other variables. You get the idea.)

Or, consider the recent revelations around heart attack symptoms. For years, researchers basically studied males and extrapolated from these studies a list of warning signs commonly believed to be true for everyone. But, as it turns out, the warning signs for women are quite different than those for men. If women had been included in these studies, or if researchers had questioned their assumptions that men and women are alike in this respect, a more scientifically accurate picture would have emerged.

What Heimlich did may seem like a small deal, but it wasn't. It was enormous. My first reaction was to question myself; maybe I was wrong about this, maybe this extrapolation was valid. But I knew better. And if I knew better, why didn't Heimlich? Could he have done this in error? Could this have been deliberate? Either way, it didn't look good.

As I tried to wrap my brain around this, I waited for the workday to begin, too unnerved to sleep and for once grateful that my editor was hours ahead of me here in California. Finally, around 7:00 am, I placed the call.

"There seems to be a problem with how Dr. Heimlich is applying his data," the first of countless times I would say this exact phrase.

I explained. He listened in silence. We were both thinking the same thing - oh shit. What could this mean for Ellis & Associates, who also relied on this figure?

The editor agreed we couldn't move forward and gave me a few weeks more to dig around; weeks that turned into months -- six to be exact.

Having only a partial copy of Quan's study, and freaking out about the implications of what I thought I was seeing, I decided to call her. It was easy enough to find the hospitals number where she worked through information. Maybe Quan would tell me that Heimlich's use of her data was correct after all.

The message I left for her was the same as what I told my editor, "There seems to be a problem with how Dr. Heimlich is applying your data."

The message I left for Hazinski was the same: "There seems to be a problem with how Dr. Heimlich is applying his data."

And then I waited. And the phone calls started coming. And papers and documents and research started arriving. And then the bad dream began to take shape.

Part III, The Straw (Man) Argument