Authored by Alejandro Hoberman, MD, and John V. Williams, MD
Jack Leon Paradise, MD, 96, recently died peacefully at his home in Belmont, Mass., on December 20, 2021. Pitt Pediatrics wishes to acknowledge the recent passing of Paradise and celebrate his many contributions to the department, UPMC Children’s Hospital of Pittsburgh and children everywhere.
Paradise played important roles in leading teaching, clinical, and research programs at the University of Pittsburgh School of Medicine and Children's Hospital for 35 years before retirement as Professor Emeritus of Pediatrics and Otolaryngology in 2005. Before joining our faculty, he was in private practice for 18 years. Paradise graduated from Johns Hopkins University School of Medicine and received residency and fellowship training in Salt Lake City, Baltimore, and Rochester, Minnesota. His research focused on otitis media and diseases of the tonsils and adenoids. His studies shed evidence-based light on broad areas of primary health care for children that previously had been clouded by uncertainty and often divergent practices. Paradise was the recipient of Research Award of the Ambulatory Pediatric Association (1994), was elected as Fellow of the American Association for the Advancement of Science (1998) and Pediatrician of the Year by the Pennsylvania Chapter of the American Academy of Pediatrics (1999). In 2000 the Jack L. Paradise Endowed Chair in Pediatric Research was established at Children's Hospital.
In the 1950s, Paradise opened a coal miners' clinic in Ohio. He found himself often called upon to recommend for or against tonsillectomy and/or adenoidectomy in children, although textbooks and expert opinions were divergent and studies unconvincing. Upon joining the faculty in 1970, he initiated NIH-sponsored clinical trials of 4000 children (1971-1994) that led to evidence-based indications for tonsillectomy and adenoidectomy. The 80% drop in pediatric tonsillectomies in the United States has been attributed to his work. Later in his career, Paradise turned his attention to another challenging primary-care question. Tympanostomy tube placement had replaced tonsillectomy-adenoidectomy as the most common surgical operation on US children, mostly for persistent otitis media with effusion, on the premise that hearing loss in early life could result in lasting impairments of speech, language, cognitive, or psychosocial development.
Paradise’s study enrolled more than 6000 Pittsburgh-area neonates, and those who developed persistent middle-ear fluid within the first 3 years of life were randomly assigned to either receive ear tubes promptly or go into a watchful waiting group that would receive tubes only if their fluid persisted. The study showed no differences in speech, language, learning, or behavior at age 3-4 years between children who received ear tubes promptly and those in the watchful waiting group, most of whom escaped tubes entirely. Similar results were reported in the same children at ages 6 and 9-11 years. The American Academy of Family Physicians, the American Academy of Otolaryngology-Head Neck Surgery, and the American Academy of Pediatrics issued a Clinical Practice Guideline which has substantially influenced child health care practices and costs, by emphasizing conservative management rather than early surgical intervention.
From 1971 to 1991, Paradise served as division chief for Ambulatory Pediatrics, and medical director for the Ambulatory Care Center at Children's Hospital. He developed a program of clinical service, teaching, and research in general pediatrics where he influenced students, residents, fellows, young faculty and colleagues. He actively organized a network of community pediatricians who became engaged in clinical research and led the development of interdisciplinary research teams. After his retirement, Paradise remained actively engaged in the design, analysis and reporting of results of three large, randomized clinical trials that evaluated antibiotics in young children with acute otitis media, duration of therapy, and the efficacy of tympanostomy tubes in children with recurrent acute otitis media. All of these were published in the New England Journal of Medicine, the last in May 2021 at the age of 95! Paradise was active in Physicians for Social Responsibility and International Physicians for the Prevention of Nuclear War, which was awarded the Nobel Peace Prize in 1985. Above all, he was known for his kindness, decency, humor, loud plaids, late-night work, indefatigable rewriting, friendship, compassion, and big heart.
Paradise’s innovative and creative approaches, scientific rigor, overall impact, and ongoing influence in intellectual stimulation and development of colleagues across the various disciplines influenced the excellence, research creativity, and scholarly activities of the Department of Pediatrics and the University of Pittsburgh School of Medicine. His deeds and his writings are an example for all clinical researchers to follow. He was a pediatric leader for all times, a man for all seasons.