Sunday, March 16, 2003

Heimlich falsely claims he invented surgical procedure

Romanian replaced esophagus years before

By Robert Anglen
The Cincinnati Enquirer

[photo] Dr. Henry Heimlich has been saying for years that he performed the world's first total organ replacement in the 1950s. But ask about Dr. Dan Gavriliu, and he changes the story.
(Joseph Fuqua II photo)
For more than 40 years, Cincinnati icon Dr. Henry Heimlich has been taking credit for a world-famous operation that was actually developed first by a Romanian surgeon behind the Iron Curtain.

In interviews, biographies and promotional materials, Heimlich has told anyone who would listen that he performed the world's first total organ replacement.

But even before Heimlich wrote his first article about the "Heimlich Operation" on dogs in 1955, the procedure had been performed dozens of times on humans by Romanian surgeon Dr. Dan Gavriliu, an Enquirer investigation has found.

Gavriliu now calls Heimlich a "liar and a thief." He says Heimlich not only took credit for the operation, but also lied when he said they co-authored a paper for an international surgery conference.

Heimlich denies any deception and says he has no idea why Gavriliu would be upset.

The operation, which uses a section of the stomach to bypass the esophagus, helped jump-start Heimlich's career as a thoracic surgeon. It led to his 1969 appointment as Jewish Hospital's first full-time director of surgery and cemented the reputation that would later make him a household name.

Heimlich developed the Heimlich maneuver that's used to expel food from the throats of choking victims.

The organ replacement procedure gave people with esophageal damage from birth defects, cancer or drinking poison a chance to eat and swallow like normal people.

`I will show you a thief'

"Scratch a liar and I will show you a thief," the 88-year-old Gavriliu said in interviews from his home in Bucharest. "His claim is a lie. I never believed that such thefts as those performed by (Heimlich) may occur and go unpunished in the USA."

Heimlich, 83, is the founder of the nonprofit Heimlich Institute, which is partnered with Cincinnati's Deaconess Hospital.

The accusation that Heimlich took credit for a procedure he didn't first invent or perform underscores recent concerns over controversial research the institute has undertaken.

Heimlich has been sharply criticized by federal and world health agencies for underwriting experiments to inject AIDS patients in China and Africa with malaria, which he says could lead to a cure for the disease. He is about to embark on an effort to raise $5 million for his institute.

Heimlich's claims about the esophagus operation have gone unchallenged in and out of the medical community for four decades.

In an interview last week, Heimlich first said that he was the sole inventor of the esophagus operation, known as the reversed gastric tube procedure. But when asked about Gavriliu, Heimlich vacillated. He immediately agreed that the Romanian performed the operation first. Then Heimlich said he and Gavriliu invented the operation independently at the same time. Then Heimlich said he invented it first in the United States.

He also said that he and Gavriliu have been friends since the 1950s, a claim that the Romanian surgeon flatly denies.

Heimlich outlined the operation on a piece of paper, explaining how he came up with the idea just after he completed his residency in New York City in 1950.

"I devised it. It was the first time an entire organ had been replaced," he said. "It got a lot of international attention."

He said he didn't know that Gavriliu had been doing the surgery on human patients until after he wrote his first paper. He said Romania was a Communist country, and doctors in the United States did not communicate with doctors behind the Iron Curtain.

"It was a coincidence," Heimlich said. "There was no contact between us."

But after Heimlich wrote about his dog experiments in the April 1955 issue of Surgery, Gavriliu did contact Heimlich. In letters to the magazine's editors and to Heimlich, the Romanian surgeon said he had been using the procedure on humans since 1951 and had successfully operated on 50 patients.

Gavriliu also submitted published reports in Romanian medical journals dating to 1951, when he first performed the surgery on a human patient.

Sharing credit, taking credit

"His letters showed me that he did it first," Heimlich said last week. And indeed, in 1957, Heimlich credited Gavriliu for the operation in a second Surgery article. He also has credited Gavriliu in some medical journals.

Despite those acknowledgements, Heimlich for years has taken full credit for the operation.

In the 1998 Encyclopedia Britannica medical annual:

"I conceived of an operation to replace the esophagus. After successfully performing the procedure on a series of patients, I presented the results at an American Medical Association meeting."

In the May-June 1995 issue of Navy Medicine:

"My specialty resulted from developing the reversed gastric tube operation for esophageal replacement. Previous attempts at replacing the esophagus out of the upper stomach and intestine were not very successful."

In Who's Who in America 2002:

"I have never been satisfied with existing methods and seek to simplify and improve them. After devising an operation for replacement of the esophagus, I became aware that with one such discovery I could help more people in a few weeks than in my entire lifetime as a surgeon in the operating room."

"Let Heimlich be a pig if he wants to steal an operation and put his name on it," says retired New York surgeon Eugene Albu. "He changed the name from the Gavriliu Operation to the Gavriliu-Heimlich Operation. Then it became the Heimlich Operation later on."

Albu, 78, was a professor at New York's Albert Einstein University. Before coming to America in 1978, he worked with Gavriliu on the reversed gastric tube operation in Romania and throughout Europe.

"We did more operations of the esophagus than many universities put together," Albu said from his home in the Bronx. "We were getting referrals from many European countries. We did the operation in Rome, Paris, Greece."

After being contacted by Gavriliu, Heimlich traveled to Romania to assist in an esophagus replacement operation in 1956.

Albu was on the operating team with Gavriliu when Heimlich assisted and filmed the procedure.

"Heimlich saw us operate, and he was very impressed by what he saw," Albu said. "He said he thought the operation was possible but never saw it done. It was only later that he started to appropriate it."

Heimlich: I did him a favor

Following the Romania trip, Heimlich wrote the second Surgery article crediting Gavriliu with performing the operation first.


But Heimlich said last week that the article was meant as neither an apology nor a correction. Rather, Heimlich said, he was really doing Gavriliu a favor. He said Gavriliu was in jeopardy from the Communist Party and needed the attention of an international audience.

"I'll tell you why I wrote it. It was to keep his name out front, so that the regime would not kill him," Heimlich said. "He was in trouble in Romania. Because of his contact with me, I could make his name known. So I published the article."

Gavriliu scoffed at this explanation. He said the Communist Party ordered him to show the operation to 60 foreign surgeons, who were sometimes allowed to assist in the operating room.

"Dr. H. was granted this privilege only once," Gavriliu said. "No friendship or scientific collaboration ensued. Dr. H. was immediately forgotten."

Gavriliu has lectured on the esophagus surgery around the globe. For years he was a doctor and professor at the University Hospital in Bucharest, where his bust has been on display since 1991. Gavriliu has been honored by several European countries, including Italy and France. In 1985, he became a member of the French Academy of Surgery, and he is a former consultant to the World Journal of Surgery, the official journal of the International Society of Surgery.

He has lectured at the Royal College of Surgeons in England and was a visiting professor at the Mayo Clinic in the United States in 1975.

A sketch on a napkin

Heimlich said he sketched the idea for the operation on a napkin after details came to him during a meeting at a New York Hospital in 1950. He struggled to get medical professionals interested in the procedure, including officials at Mount Sinai Hospital. Undaunted by their disinterest, Heimlich said he got a small grant to experiment on eight mongrel dogs.

Heimlich performed his first successful esophagus operation on a human patient on April 20, 1957, at New York Medical College-Metropolitan Hospital Medical Center.

The same month Heimlich wrote the second Surgery article, he presented a paper supposedly coauthored by Gavriliu to the 1957 International Society of Surgery conference in Mexico.

But Gavriliu said he never heard of the paper until being contacted last month by the Enquirer. He expressed outrage that Heimlich would put his name on a paper and suggested that Heimlich was looking to legitimize his claims that he invented the operation.

"I am nobody's fool," Gavriliu said. "I performed thousands of esophagus operations. I have been to congresses all over the world."

Heimlich said he doesn't remember if Gavriliu assisted in the Mexico presentation. Heimlich said even if Gavriliu didn't know about the paper, he was only trying to make sure the Romanian got credit for the operation.

But in 1960 and 1961, when Heimlich presented the operation at medical conferences in the United States, claiming he had performed the world's first organ replacement, Gavriliu was barely mentioned, if at all. The Oct. 26, 1960, New York Times, crediting Heimlich, described "his technique" as a new operation and reported the results of several patients.

`Popularizing' procedure

Some medical journals credit Heimlich with "popularizing" the esophagus operation in the United States, while others don't mention him at all.

Physician's assistant Greg Burke, of Maryland, has written a history of the esophagus operation. He said Heimlich was not even the first doctor in North America to perform the operation. He said Heimlich was just the first person to make it known in the United States.

"Medicine is quite an arrogant business. (Doctors) are all looking for credit," Burke said. "I get so tired of it in medicine because everyone wants to be the first."

Burke, whose 12-year-old daughter, Jaclyn, was born without an esophagus, now runs a nonprofit support group for parents of children born with birth defects.

He said the esophagus operation gave his daughter a chance to live normally without having to rely on a feeding tube to the stomach for food. He said she can swallow, but because there is no muscle to control reflux, food can come back up.

"If she stands on her head, food will come back up," he said.

Jaclyn will always be at risk for pneumonia, bronchitis, asthma and reflux, any one of which could be fatal, Burke said.

Burke said Gavriliu is recognized as the international authority on the operation, and he has talked to the Romanian surgeon on several occasions.

"Do you know how much he was being paid as a surgeon? Seventy-five dollars a month. His wife is a doctor, too," Burke said. "I have talked to a lot of eminent physicians here and in London and in Europe. They all believe that Gavriliu was the first to do it."

Friendship? No

Heimlich said that he and Gavriliu stayed friends long after the 1956 surgery. He said they even took a train trip together to the Black Sea in 1960.

But Gavriliu said that he and Heimlich had no friendship.

The Romanian surgeon said he did not go looking for attention and insisted that he doesn't need to bolster his reputation. But he doesn't think Heimlich should be allowed to continue making claims about the operation.

"Heimlich thinks that I am too old or too tired to fight for the truth," he said. "He is wrong."


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