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People are dying because rescuers don't use the Heimlich maneuver on drowning victims, Dr. Henry Heimlich says repeatedly. He can't understand why the world's authorities on drowning rescues can't see what is so obvious to him.

The research is "all out there," Heimlich said. "It's been on our Web site."

The most comprehensive drowning paper on www.heimlichinstitute.org is Heimlich's chapter in a 1999 drowning-prevention book compiled by the International Swimming Hall of Fame. Scientific Facts Show Heimlich Maneuver Best Method For Drowning, it's titled. It contains no raw data.

Heimlich has published articles in independently reviewed journals. The American Red Cross included three in a 2000 report, which reviewed 18 drowning studies addressing the Heimlich maneuver.

The Red Cross found no independent evidence in Heimlich's papers. It described them as giving a "general description" of the maneuver, the "rationale for performing" it and "anecdotal case reports" of rescues.

"I have yet to see any rigorous attempt by him to demonstrate the maneuver is superior through data and experimentation, which is the essence of science," said Dr. Robert Baratz, president of the National Council Against Health Fraud.

Heimlich and the drowning authorities clearly have different notions of what constitutes obvious research conclusions. As a result, they can look at the same reports and still dispute:

• The effect of inhaled water

"Every scientific study shows water fills the lungs," Heimlich often says. "Not one study showed that CPR is beneficial for drowning unless water is first expelled from the lungs."

Reminded of studies that show otherwise, Heimlich has suggested in letters, articles and interviews that researchers misrepresented their own data.

For evidence that water fills the lungs, Heimlich cites a study by Dr. Jerome Modell, an internationally honored drowning researcher who retired in 2001 from the University of Florida. But the study included no survivors, and Heimlich quotes the maximum amount of water in all the victims' lungs even though most had far less, Modell said.

"He's taken bits and pieces of things I've said over the years totally out of context."

Our bodies don't let fluids into our airways, which is why we cough our drinks back up when something goes down the wrong pipe. Water can reach an unconscious person's airway. But the bloodstream quickly absorbs fresh water, Modell said, and only a suction device can actively remove sea water.

"I know there's a false report that there's little or no water in the lungs," Heimlich said. "I'm taking issue with that now."

• The Heimlich maneuver's ability to remove inhaled water

Researchers can't pour water into people's lungs to see how well the maneuver removes it, so Peter Safar used anesthetized dogs at his University of Pittsburgh lab. Known as the father of mouth-to-mouth resuscitation, Safar said it was already established that drowning victims could be removed without removing that water.

Safar's September 1982 Anesthesiology report found "no significant difference" between using four Heimlichs and letting gravity drain the lungs at a 30-degree tilt.

"That study proved people drown because their airway is blocked," Heimlich said. "They found that four Heimlich maneuvers completely cleared that water from the dogs. That's just black and white."

Safar died in 2003, but told the Pittsburgh Post-Gazette in 1999 that his animal studies on drowning "did not find that the Heimlich Maneuver had much to offer. You can't get water out of the lungs unless you put air on top of it."

Heimlich gives several examples where victims were seen coughing out water after rescuers used the maneuver. But the examples "did not prove that the water obstructed the airways, or that the water came from the lungs rather than from the stomachs," Dr. Linda Quan wrote to the Journal of the American Medical Association in 1993. She's a pediatric drowning specialist at Seattle Children's Hospital and the University of Washington.

• Whether anyone recommends the Heimlich in drowning rescues

No major resuscitation council recommends using the Heimlich maneuver as a first step in drowning rescue. When asked about that unanimous rejection, Dr. Henry Heimlich disagrees by citing a group that recommends it as a second step, if CPR doesn't work.

"The Red Cross says if they don't recover after mouth-to-mouth, use five Heimlich maneuvers," Heimlich said.

The American Red Cross said issued a special advisory on drownings in 2000, which said, "The Heimlich maneuver may be performed" if a solid obstruction appears to keep rescue breaths from helping. But the same advisory statement emphasized independent researchers' unanimity against using it for any other reason.

More recently, the Red Cross's 10-page 2005 Guidelines for First Aid (www.redcross.org/static/file_cont4913_lang0_1727.pdf) last December did not mention the Heimlich maneuver or the synonymous "abdominal thrust" in any context. Its drowning section, however, referred to it indirectly:

"There is no evidence that water acts as an obstructive foreign body, so don't waste time trying to remove it."

• The effectiveness of CPR (mouth-to-mouth breathing and chest compressions)

"The different studies have shown over the years that with CPR alone, invariably there are 50-to-60 percent deaths," Heimlich said.

Death rates in drowning rescues depend greatly on the victim's condition when revival attempts begin. Eighty percent would be a low death rate for those without a pulse, and 5 percent would be high for conscious swimmers.

"So you can find whatever success rate you want," said Dr. Alan Steinman, the Coast Guard's former chief medical officer and frequent adviser for official rescue protocols.

In the 2000 Red Cross analysis, evidence in seven studies led to recommendations for CPR. Quan wrote of one, "All victims receiving some degree of CPR did better than those who had none; the ones who received full CPR did best."

• The safety of CPR

But CPR is dangerous, Heimlich said. Chest compressions can break bones. And mouth-to-mouth is so harmful, the American Heart Association even approved compressions without rescue breaths for laymen reviving heart attack victims. A study last year found higher survival rates without mouth-to-mouth.

"So how can you possibly consider using mouth-to-mouth for drowning victims who have water in their lungs?" Heimlich said.

Drownings and heart attacks are different, Baratz said. Heart attacks affect circulation, so compressions are the highest priority. Drownings affect oxygen levels, so rescue breaths are paramount. A heart-attack rescue is no more appropriate for drownings than cholesterol drugs are for pneumonia.

"The essence of medicine is to get the diagnosis right, and then get the treatment right," Baratz said.

Heimlich is undaunted. He said it took experts 12 years to embrace the Heimlich maneuver for choking rescues. He's confident it's only a matter of time before the establishment's red-faced acceptance that he was right all along about drowning.

But Heimlich's assertions are "not the opinion of a maverick," Baratz said. "He talks as if, 'You've got to believe me because I'm different and I was right before.' His advocacy of the maneuver for drowning is, in fact, quackery."

What Baratz calls quackery, Heimlich calls innovation. "I just stick to the facts," he said. "The scientific facts spell it all out."

Contact this reporter at (937) 225-2129 or klamb@DaytonDailyNews.com.