Dr. Richard Schwartz on the Benefits of Thinking Big and Staying Small

Rebel With a Cause

During his residency, Dr. Schwartz’s formidable curiosity took him beyond standard duties. When he wanted to learn how to perform a tympanocentesis, he asked an ENT resident to show him. Though only ENT personnel performed them at the time, he did a handful on his own. “I did some alone, at night, asking the guard to open up the ENT suite, so I could grab some of the instruments, do my thing, then quickly put it back and wash it off, and then leave them a note that I did that. That took chutzpah!”

He also developed a love of microbiology, cultures and infectious diseases. “I loved that, I was good in that.”

He’d ask residents on the infectious disease ward if they had any interesting cases. He once earned recognition from the hospital chief by thinking outside the box and cracking an arsenic poisoning case on the ward. They had a child with vomiting, diarrhea, fevers, irritability, and “the crazy thing is the kid’s losing his hair.” Suspecting heavy metal poisoning instead of an infectious disease, he marched a urine test down to the lab and requested a hot copper wire test. It turned out that a nanny was poisoning her wards, and Dr. Schwartz saved the patient’s life with the simple bedside test. In the following Friday’s conference in infectious disease, the hospital chief said: “Schwartz? Is Schwartz in the room? I think we ought to give Schwartz a big hand.”

After his residency, Dr. Schwartz joined a pediatric primary care practice with three other physicians. With his enduring passion for microbiology and experience processing tens of thousands of cultures at Children’s under Dr. Margileth, he was eager for a lab. His colleagues were not opposed, but only lukewarm on the idea. So, he paid to set it up himself. “My first incubator was from Sears; it was a chicken egg incubator, and that was my start.”

However, it wasn’t long before his colleagues had an epiphany. The practice only charged $7 for an office visit ($8 if you had to come in on the weekend), and Dr. Schwartz charged $5 for a culture. “So, they said: ‘This is good.’” Soon, they all learned to process cultures, and the practice enlarged the lab.

He maintained an academic social link with several people in microbiology at D.C. Children’s Hospital after he left, which led to perhaps a thousand referrals once he was in private practice. “Every antibiotic that came out, I would get referrals from Children’s because nobody at Children’s besides ENT could lance an eardrum—and culture it. I didn’t have to take them to the operating room, which was their way of doing it. I just did them in the office.”

It was during this time that Dr. Schwartz somewhat inadvertently began his research and publishing career. The combination of his extensive work with ear infections, antibiotics and cultures led him to question a standard protocol and then prove it wrong.

The practice at the time was to treat patients with ear infections who were under age 5 with ampicillin, and treat patients over age 5 with penicillin. Physicians used ampicillin to treat Haemophilus influenza, which caused ear infections. However, there was a widely-held misconception that H.influenzae rarely caused infections in children over 5. Therefore, they assumed patients over 5 had pneumococcus and treated them with the appropriate antibiotic, penicillin. However, Dr. Schwartz was finding a lot of H.influenzae in the cultures he performed on older children. “So, I said: ‘This is nonsense!’  But nobody else had done [the research].” By completing studies that proved that H.influenzae did cause infections in patients over 5, he stopped the protocol of switching antibiotics.

When Dr. Schwartz reported his findings, they were published in the Journal of the American Medical Association (JAMA). “When I did my first publication, it was in JAMA. That’s unheard of, a first publication in JAMA.” He added, “That made me a big person right away.”

He loved that he had made a small contribution to the field and changed the way pediatrics was practiced. He started attending ENT conferences and networking with others from universities across the U.S. “I kept on thinking of things—‘How can I improve it?’ I would sit in my chair, I’d go in the shower, and I’d think: ‘This sounds like it would be a neat thing to try.’ I’d scratch out a diagram of how to do the study.”

Dr. Pichichero agrees: “He asks practical questions that every pediatrician asks themselves. The difference is that, when there is a question to be answered and the answer is not known, then he does a study to answer it.”

There were very few grants for his research, so he funded almost all of his studies himself. “Funding was difficult, but we could underwrite ourselves using our other successful pharmaceutical grants.”

Throughout his research career, he has continued to undertake evidence-based studies that challenge unproven protocols and paradigms. With the recent legalization of marijuana, many studies he completed in the 1980s, 1990s and 2000s about the underestimation of the effects of marijuana on adolescents and its efficacy as medicine are part of the public dialog.

He believes people become addicted to pot very quickly and develop lifestyles that are compatible with the drug. “If you start smoking [pot] at a time when it’s going to affect you [developmentally], or you become a daily smoker, it’s going to erode your ability to function at your highest. It’s going to erode your goal seeking behavior. You don’t give a damn.”