WITHOUT ANIMALS: ADVANTAGES AND SAFETY OF CLINICAL RESEARCH
Henry Heimlich, MD.
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From the Proceedings of the First International Medical Conference Against Vivisection. Israel, 1989I would like to talk about what can be done with clinical research and why clinical research can not only be much more successful than any animal research but how it can be done safely.
The Heimlich Institute
"The Heimlich Institute" sounds very impressive. We're proud of our work, but I'd like you to know there are only four of us. We carry out research, however, around the country and in other countries, at different institutions. What I tell you may sound simple because you're seeing the finished product. Please bear in mind that the things told in moments, and the decisions seemingly made in moments, have taken many years to come to fruition, in several cases.
The Reversed Gastric Tube Operation
The reversed gastric tube operation, the Heimlich operation for replacement of the esophagus, which I came out with in the 1950's, is very simple. It is a matter of replacing the esophagus by making two tubes out of the stomach, which is really one large tube, and carrying the blood supply with the part of the stomach that will become the new esophagus. The new tube is made from the stomach, by inserting a double row of staples and cutting between them. Then you rotate this tube upward and join it to the throat and the new tube becomes the new esophagus. The old diseased esophagus is closed off and the person can eat normally. I am pleased to say that when I go to children's hospitals today, invariably the surgeons there tell me they used my esophogeal replacement operation the previous week, most often on birth defects - congenital defects of the esophagus that have prevented swallowing and which, prior to this operation, required feeding through a gastronomy tube. I'd like to tell you that I first did the operation in a dog because that's the way I was trained to do things. I well remember though, not only the anguish I had for the animal we used, but also, in the laboratory where I then worked, seeing half a dozen little puppies whose backs had been broken. They were paraplegic and dragging their hind legs behind them and I can tell you that I never heard of anything coming out of those experiments on those dogs. Nothing at all. As I look back, we could have very easily performed the esophagus operation on the first patient since he had inoperable, incurable carcinoma. It was so sound logically and physiologically that there should have been no objection.
The Heimlich Chest Drainage Valve
The next thing I'd like to mention is what is known as the Heimlich Chest Drainage Valve. In writing a book at one point in the 1960's, I was describing this apparatus that is used in hospitals to drain the chest after chest surgery. In describing it I said the fluid and air came out through the chest tube after surgery, but cannot flow back because of this complicated device, just like a valve. It was a simple step, then, to devise a valve which could replace the complicated system. As the lung expands, acting like the piston of a pump, it pumps out air and fluid from the chest, so the lung will not collapse.
The Heimlich Chest Drainage Valve was used extensively in our war in Vietnam and saved thousands of lives. You may be interested to know that in 1967 I rushed a case of these valves to an airport in New York where they were flown here to Israel and were used extensively in the '67 war and thereafter. In fact, every emergency kit in this country and in most countries contain the valve. A simple plastic device. An ordinary chest tube is attached to the valve. On the battlefield, the tube is inserted into the chest through the bullet wound, a dressing is placed around it, and the valve is attached to the tube so that the air and fluid can flow out and nothing can flow back in. How was it tested? After being convinced it was a sound concept, I bought a simple toy, a piece of flattened tubing - we call them a "Bronx cheer" in New York. It was the equivalent of a flutter valve. I attached it to tubing and sterilized it. When a patient came with a collapsed lung from pneumothorax, air in the chest, I simply attached this valve to his chest tubes and sat with him all day. And it worked. No animal experiments were required, and no other studies. I was able to convince the Becton-Dickinson Company (B-D) to manufacture the valve and it has since been distributed in the hundreds of thousands a year.
The Heimlich Micro-Trach
A more recent device we've been involved with has to do with giving oxygen to patients with emphesema and other chronic lung diseases. You've seen people tubes around the head and the oxygen going in through prongs in the nose; nasal canulas. They're very irritating to the patient's nostrils. But in addition, you see these patients struggling for each breath. Why are they struggling? Because with every breath, they've got to suck the oxygen through what we call the dead space, from the nose on down to the chest. They are tied down to big tanks. Why? Because so much of the oxygen, 50% - 60%, is lost coming back out of the nose and the mouth. As a chest surgeon, I knew that when a patient is not breathing well you perform a tracheotomy. A tracheostomy tube is inserted into the trachea, and they immediately breathe easy because you bypass the dead space, i.e., the patient does not have to suck air through the throat and larynx to get oxygen into the lungs. You can also get oxygen directly into the lungs by putting a catheter into the tracheostomy tube, and can suction out secretions that block parts of the lungs. The problem with a tracheostomy is that a person cannot speak and it's an opening through which contamination can get in and cause pulmonary infections. To overcome these problems, yet retain the benefits of tracheostomy, I simply created a small device, the size of an intravenous catheter, a very tiny tube that is put in under local anaesthesia, directly into the airway. It's held in place with a jewelery chain around the neck. Through this catheter you can administer oxygen directly to the lungs, so the patient breathes normally without straining. You're also not wasting oxygen, since all the oxygen goes into the lungs, so a small container can last the whole day. There is no opening, and therefore, the patient speaks normally and contaminants cannot enter. When the patient is dressed, you don't know that he's taking oxygen because the tube runs under the clothes and out to the container. He carries a small container which will now last a good part of the day. These patients are made mobile and, also, their appearance is of course improved. This was the first patient with a Heimlich Micro-Trach, and I can tell you, I didn't do any dogs before him. What would we have learned - and I know the demand was there to do it in dogs - what would we have learned by putting a tube into dogs? Absolutely nothing. We've been doing tracheotomies for years, a much more major operation. People have plastic tracheostomy tubes for years when their larynx has been removed for carcinoma. In 1980 ,we went ahead and did the procedure in a patient, who now carries a small oxygen tank in her purse.
Cystic Fibrosis
We have treated hundreds of these patients and the procedure is being done around the country and is approved by the FDA. We found that by putting a little saline solution into the Heimlich Micro-Trach, it forces a cough that expels secretions and also loosens the mucus. It seemed logical - logical is the operative factor - that if we used this method in cystic fibrosis (CF), it would clear out the secretions that kill CF patients. Ninety-eight percent of CF children die because of the thick secretions in the lungs, causing infections and destroying the lungs. They die mostly in childhood or adolescence. Some now get to over age twenty. So if you put the Micro-Trach into the CF patient and they squirt a little saline solution through it, it obviously loosens the secretions, which they cough up. In the last year-and-a-half, we have enlisted six cystic fibrosis centers in children's hospital at universities around the United States - and we'll be happy to do it here in Israel, if you wish - and we have been starting to treat these children. What sense would there have been to try to do animal experiments? It was possible to go to the internal review boards (IRB's) of these institutions, which decide whether you can do "human experimentation", and they all agreed that we could go ahead and do it. The logic was there. It is possible to convince the people in these clinical areas to proceed with a previously untried procedure, if you can show the logic and can convince them of its importance. The CF program has progressed well enough so that we are now expanding to 5 or 6 more CF centers and by the end of the year, we will have collected enough data - no animal experimentation - enough data to have proved the procedure that is literally turning lives around for these children.
References:
1. Heimlich HJ: Oxygen delivery for ambulatory patients: How the Micro-Trach increases mobility. Postgraduate Medicine 84:68-79, 1988.
2. Heimlich HJ and Patrick EA: The Heimlich Manoeuvre: Best technique for saving any choking victim's life. Postgraduate Medicine 87:38-53, 1990.
3. Heimlich HJ and Patrick EA: Using the Heimlich Manoeuvre to save near-drowning victims. Postgraduate Medicine 88:62-73, 1988.
4. Orlowsky JP: Effects of tonicities of saline solutions on pulmonary injury in drowning. Critical Care Medicine 15:126-130, 1987.
5. Safar P: Resuscitation following fresh-water or sea-water aspiration. Acta Anaesthesialogica Scandinavia (Suppl.) 3:99-107, 1961.
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