July 3, 2013 Regina M.

Benjamin MD MBA United States Surgeon General 1101 Wooton Parkway Rockville, MD 20852 Dear Surgeon General Benjamin: I greatly appreciated you, Chief of Staff Robert DeMartino MD, and Policy Advisor Dawn Alley sharing so much time on the phone with me this past Thursday afternoon. I also appreciated your offer to share the information I've brought to your attention with (soon to be) Acting Surgeon General, Boris D. Lushniak MD, and for your request to review and to forward to him the following information for a possible review of HHS choking rescue recommendations. You'll recall that in my June 10, 2013 letter, I shared information and links to published information re: the current choking rescue guidelines of the American Heart Association, American Red Cross, and the International Liaison Committee on Resuscitation (ILCOR). The purpose of this letter is to share concerns regarding the quality of evidence on which Surgeon General C. Everett Koop based his September 30, 1985 Public Health Report. Please click here to download a 41-page pdf file consisting of the documents referenced below. Via Heimlich Maneuver Endorsed – Surgeon General Calls It 'Only Method' to Aid Choking Victims by Cristine Russell, Washington Post, October 2, 1985 Yesterday, as the U.S. surgeon general, Koop endorsed the life-saving Heimlich Maneuver "as the only method that should be used for the treatment of choking from foreign body airway obstruction" and prodded the American Red Cross and American Heart Association to move more quickly in adopting it exclusively. ...He urged that other methods be dropped immediately as "hazardous, even lethal," particularly the traditional use of sharp blows to the back that he said can drive a foreign object even deeper into the throat. In doing so, Koop jumped into the middle of a long-running controversy in the public health community over the place of the Heimlich Maneuver in first aid procedures..."Dr. Koop and Dr. (Henry) Heimlich are not giving the process quite the chance it deserves," responded Red Cross senior vice president Dr. Lewellys Barker. Koop said in an interview that he felt the need to act more quickly after receiving letters from Heimlich and University of Cincinnati professor Edward A. Patrick...Patrick, who has performed research showing that the back slap can drive a foreign object downward, complained to Koop that the "lives of many Americans are endangered as the result of Red Cross first aid instruction" and said "it is urgent that you inform the public through the media of the back slap danger." Please see pages 4-8 of the pdf for copies of letters exchanged at the time between Dr. Heimlich (my father), Dr. Patrick, and Dr. Koop. Via Red Cross slapped on first aid methods for choking victims by Steve Twedt, Pittsburgh Press, October 2, 1985: The US. surgeon general says the Red Cross and other organizations are teaching a dangerous method of first aid for choking victims. But national Red Cross officials disagree and say they will continue to teach a method that includes slapping a choking victim on the back, a potentially deadly approach according to the surgeon general. "If we had any evidence at all that the backslap is dangerous we would declare a national emergency and immediately tell CPR (cardio-pulmonary resuscitation) classes that are teaching it," said American Red Cross spokesman Brian Ruberry in Washington.

Ruberry said the Red Cross believed US. Surgeon General Dr. C. Everett Koop may have based his decision on erroneous information. ...Koop's recommendation is based on research by Dr. Edward Patrick, a professor of electrical and computer engineering at the University of Cincinnati. In studies of 1.400 choking cases. Patrick said the backslaps increased by four-fold the chances of complications for a choking victim including unconsciousness or death. Dr. Henry Heimlich. originator of the Heimlich maneuver, also was involved in the research. Ruberry said Red Cross officials did not consider the Patrick study scientifically sound. To my knowledge, Dr. Patrick never provided copies of his research to Dr. Koop. He simply described it in his August 16, 1985 letter (page 6-7 of the pdf). Further, the study was never published in a journal. Therefore, it's unclear why Dr. Koop found Patrick's work so persuasive. Further, as suggested by the title of his full-page obituary 1 by Jeanne Lenzer published in the March 13, 2010 British Medical Journal -- Edward A Patrick: Championed the Heimlich manoeuvre, in a life embroiled in scandal (page 9 in the pdf) -- Dr. Patrick's credibility is at issue. Via Heimlich Associate Loses Libel Suit by Stephen Barrett, MD, Casewatch, December 2009 which includes Federal Court Judge Lesley Well's October 20, 2008 Memorandum of Opinion and Order Granting Defendant's Motion for Summary Judgment: A federal court judge has dismissed a libel suit brought by Edward Patrick, M.D. against the Cleveland Scene newspaper and Thomas Francis, a writer whose cover story, "Playing Doctor," had accused Patrick of lying about his professional experience. Patrick is board-certified in emergency medicine, based on a one-year residency program followed by credit for practice. However, critics believe he did not complete residency training. The newspaper article also questioned the veracity of data from Patrick that were used to establish the Heimlich maneuver. as a method for treating choking. As noted below, the judge concluded that Patrick misrepresented the extent of his medical training and failed to present credible information to rebut other accusations made in the article. Patrick appealed, but in December 2009 the appeal was dismissed. If you're interested in learning more about the case, please click here for a 779-page file consisting of the February 2, 2008 Defendant's Motion for Summary Judgment and exhibits that resulted in Judge Well's decision. Again, thank you for time on the phone and also for your continued attention. After the information has been processed, I'd welcome being informed by a staff member in your department whether or not these matters will be recommended for further review. Sincerely,

Peter M. Heimlich 3630 River Hollow Run Duluth, GA 30096 ph: (208)474-7283 website: Medfraud blog: The Sidebar cc: Robert DeMartino MD, Dawn Alley PhD

1 Click here for Dr. Patrick's paid death notice published in the Wheeling, WV News-Register.

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