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The Masterful Marketing of the Heimlich Maneuver

Despite its fame, the technique wasn't backed by very much science.
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(Photo: nicksherman/Flickr)

(Photo: nicksherman/Flickr)

Awhile back, I choked on a piece of beef stew. It happened as these things usually do: One minute I was happily sitting in a Dominican restaurant down the block having a "business lunch" with a friend, and the next I couldn't breathe. This was not ideal. I calmly got up, found a glass of water, and chugged half of it, but that didn't solve the problem. My friend, now concerned, asked if I was choking. I nodded. He gave me a look that was equal parts "uh oh" and "this is going to be so embarrassing," then proceeded to give me what he thought was the Heimlich maneuver while the rest of the restaurant's patrons looked on in confusion. After five or six chest compressions, the hunk dislodged, and I rejoined the land of the breathing.

Sheepish but alive, we left, got some coffee, and discussed what a scene we had just made. There is no subtle way to perform the Heimlich, which involves vigorously squeezing the choking victim's stomach from behind in an effort to use the remnant air in his or her lung's to force the food up and out of the larynx. The only thing more visible, perhaps, is the intensity and passion with which its inventor, Dr. Henry Heimlich, went about selling his creation.

"It was an old man telling tales."

In the early 1970s, the prevailing wisdom on treating choking victims was to hit them on the back. Heimlich, after experimenting on anesthetized beagles and eventually humans, developed his technique. In an Emergency Medicine article titled "Pop Goes the Cafe Coronary,” he expounded upon the superiority of his method.

Officials from the American Heart Association and the American Red Cross, however, weren't so sure about its effectiveness. Dr. Roger White, who chaired the committee that looked into making such recommendations, said there was never any science backing the success of Heimlich's creation. There were concerns about safety, as bruising and worse can result from abdominal thrusts. Still, they recognized the utility of the Heimlich and recommended that rescuers attempt it if a series of back blows failed.

Heimlich wasn't satisfied with his method being a back-up plan. He went straight to the public, appearing on TheTonight Show, selling Heimlich Maneuver posters, and calling back blows "death blows.” Slowly, the campaign worked. Public opinion turned, then the medical profession did as well. In the mid-1980s, the AHA and ARC reversed their decision and made the Heimlich the primary way to treat choking victims.

Heimlich won, not with science but with a strong marketing campaign. Jason Zengerle, writing in the New Republic, explains this best:

Indeed, Heimlich's achievement was not so much the maneuver itself but the vigorous and sometimes underhanded campaign he waged to promote it. Heimlich's genius—one that has been adopted lately by everyone from drug companies to war planners—was to circumvent the experts and take his case directly to the people. A showman as much as a scientist, a brawler as much as a doctor, Heimlich was the P.T. Barnum of medicine—his career serving as testament to the fact that even the supposedly fact-based medical realm is susceptible to the phantom powers of personality and salesmanship.

After his victory, Heimlich didn't stop. He tried to get the medical establishment to approve the maneuver as a treatment for asthma and drowning. The Institute of Medicine gave him a hearing in 1993 regarding drowning, but they came away unaffected and a report they issued in 1995 had the same conclusion. "[Heimlich] kind of impressed me as a guy who doesn't really know anything about research science," Peter Rosen, the chairman of the IOM committee, told Zengerle. "It was an old man telling tales."

Heimlich failed, but his invention became the de-facto anti-choking measure. Everyone knows it, and knows his name. But Heimlich had his detractors, who argued that while the maneuver was effective, it wasn't the be-all and end-all of choking cures. It should be used in conjunction with other methods. The critics stayed quiet, however, mostly out of fear. Charles Guildner, an anesthesiologist and consultant to AHA's emergency cardiac care committee, found that chest blows were more effective than either back blows or the Heimlich, which is an abdominal thrust below the rib cage. After discussing his findings, Heimlich attacked him in the press and in letters to his peers. "I think what happened to me caused others to stop and think before going up against Heimlich," Guildner said. (Australians never used the Heimlich as its "resuscitation experts believe that there isn't enough scientific evidence to support its use.")

Still, the discontent continued, and the Heimlich dominance finally ended in 2005. A study the previous year helped show the value of back blows, which was enough evidence to re-open the conversation. (Heimlich's son, Peter, came out and said his father was a fraud, which is an entire tale on its own.) The American Red Cross Advisory Council on First Aid and Safety changed its recommendation, teaching that a conscious choking victim should receive five back blows before rescuers moved on to five abdominal thrusts. That recommendation continues today, despite the fact that the decisions was said to "horrify" Heimlich. In 2013, the 92-year-old Heimlich made a final push to return his method to dominance, but the prevailing medical community didn't agree. "To the best of my knowledge, after doing a pretty thorough literature search, no controlled studies exist comparing back blows to abdominal thrusts or anything else," Dr. Richard M. Bradley, a member of the Red Cross' Preparedness, Health and Safety Services advisory council and an associate professor of emergency medicine at the University of Texas Medical School at Houston, toldUSA Today.

A little air has gone out of Dr. Henry Heimlich's claims, but he still saved thousands of lives. He was a smart doctor and a better marketer. His name will live on forever.

If you ever run into him, give him a pat on the back to celebrate his success.