Paradise’s research on tonsillectomies and ear tubes was groundbreaking

Jack Paradise

Jack L. Paradise, a professor emeritus of pediatrics and otolaryngology whose innovative, rigorous and lengthy studies have prevented decades of children from undergoing needless tonsillectomies and ear tube surgery, died on Dec. 20, 2021, at 96.

“He was such a large contributor to both the institution and the community, not only locally but nationally, with the kind of impact we would all dream of,” said John V. Williams, faculty member in pediatrics and microbiology & molecular genetics. “There are a lot of physicians who are great researchers. There are a lot of physicians who are great clinical doctors. There are not that many who are great at both. Jack was. He set a model for people.”

As Paradise’s department noted in its memorial, his studies “were marked by clarity, elegance of design and adherence to clinical epidemiological principles and shed evidence-based light on broad areas of primary health care for children that previously had been clouded by uncertainty and controversy and characterized by conflicting and often divergent practices.”

Paradise earned his MD from Johns Hopkins University School of Medicine and undertook his residency and fellowship training in Salt Lake City, Baltimore, and Rochester, Minn.

In the 1950s, before joining Pitt, he teamed with other physicians to start a coal miners’ clinic in a small industrial town in Ohio. The Bellaire Clinic gave miners and their families access to free, full health care funded by the mineworkers’ union. The clinic received a 1967 federal grant to become the first Neighborhood Health Center in the U.S. outside an urban setting.

By 1966, Paradise was volunteering as a pediatrician at Pitt’s Cleft Palate Center, where he noted the association of cleft palates with ear infections and hearing loss, prompting early detection and treatment of the condition.

His research was groundbreaking even as a fellow, when he was able to dislodge the then-prevailing idea of the origins of colic in infants — that it was caused by mothers’ emotional state. Overall, his research focused on the management of otitis media with effusion — ear infections involving fluid build-up — and tonsil and adenoid disorders.

In 1970, he joined the Pitt faculty and became director of the Children’s Hospital outpatient department. There he began a series of pioneering decades-long studies — the first examining a question he first encountered as a practicing physician: Did severe throat infections lead to future illness and necessitate tonsillectomies or adenoidectomies? Finding no need for such widespread operations, Paradise’s findings led to an almost 80 percent reduction in pediatric tonsillectomies in the U.S. by the end of his study period.

Paradise then undertook another large study on the question of whether tympanostomy-tube placement was necessary in kids with persistent ear infections involving fluid accumulation. These ear tubes had been used with the intention of preventing impairments in speech, cognitive and psychosocial development, but no significant differences between ear-tube recipients and those who went without them were found, prompting pediatric physician associations to recommend alternative interventions.

From 1971 to 1991, Paradise was division chief for Ambulatory Pediatrics and medical director for the Ambulatory Care Center at Children’s Hospital, developing programs for teaching, clinical service and research in general pediatrics. He worked to organize community pediatricians into researchers, and developed interdisciplinary research teams that included ear, nose and throat specialists and those focused on infectious diseases, behavior, communication disorders, reading, psychology, epidemiology, biostatistics and audiology.

Even past his retirement, which came in 2006, Paradise was still active in three studies looking at the use of antibiotics in children with acute ear infections, the length of therapy for that condition, and the use of tympanostomy tubes when that condition recurs. All were published in the prestigious New England Journal of Medicine (NEJM), most recently in May 2021.

“We submitted a paper yesterday that he helped us analyze,” marveled Alejandro Hoberman, who knew and worked with Paradise since Hoberman’s arrival at Pitt in 1989. Hoberman now serves as the Jack L. Paradise Distinguished Service Professor of Pediatrics, and Clinical and Translational Science, a chair created in 2000 by Children’s Hospital of Pittsburgh.

Paradise was known as the oldest living NEJM contributor, but Hoberman corrects that notion: “According to the editor, he wasn’t the oldest, but he was the best.

“He was the main reason I came to Pittsburgh, to work with him,” Hoberman recalled. “He was my mentor and guided me in every research step I took in my life. He was known for his elegant and sophisticated study designs and always trying to answer the right clinical questions. At every step of the way, he didn’t take shortcuts — the best interest of research participants was paramount to him.

“He was undeniably the best mentor for research assistants and fellows,” Hoberman continued. “I tried to model everything I learned from him. In my mind, his ideas and his writing should be an example for clinical researchers to follow.”

Hoberman described Paradise as soft-spoken and caring, dedicated to helping the most underserved children at Children’s Hospital. Paradise would sit with parents of children in his research studies and urge them to decide on their participation based on what is best for their own children. “I’ve known him for 32 years. I believe doing the right thing is what I learned from him.”

Paradise received the 1994 Research Award of the Ambulatory Pediatric Association; was elected in 1995 as a fellow of the American Association for the Advancement of Science; and in 1998 was the first recipient of the Jack Paradise Investigators Award from the Pittsburgh Pediatric Society. He also received the Robert Ruben Research Award of the Society for Ear, Nose, and Throat Advances in Children in 1999, and that same year was named Pennsylvania Pediatrician of the Year by the Pennsylvania Chapter of the American Academy of Pediatrics.

When John Williams was an intern at Children’s Hospital (1994-1995), he was able to watch Paradise in action as a physician every week.

“He was a model of patience and just a marvelous clinical teacher,” Williams recalled. “He taught me how to do ear examinations and remove ear wax, which sounds simple but is actually difficult to do without tormenting the child.”

He watched Paradise instruct the child’s parent to have the child lie down for the procedure. Then Paradise pulled out a custom otoscope head he had invented — still called the Paradise — which combined a magnifying glass and a small loop for wax removal. “He made it look effortless and fast with minimal discomfort for the child,” Williams said. “And I thought, that’s the gold. That’s my standard.

“A lot of our current trainees are benefiting from his impact and they don’t even know it,” Williams concluded. “We should remember our history — he is a big part of our history here in Pittsburgh and in pediatrics.”

— Marty Levine