Theron Randolph, M.D.: An example for us all
His work taught many about the role of allergy and mental health; his example changed the professional path of countless professionals.
UNCOMMON PRACTICE: A Doctor Who Listened
Editor’s Note: I met Dr. Randolph and wrote this story seven years ago. The good doctor has passed away, but I think his story is still compelling and inspiring.
This was a story about a revolutionary, a mutineer on the ship of medicine.
Yet at age 86, with failed eyesight and dapper, conservative attire, Theron G. Randolph, M.D., hardly appeared controversial, much less revolutionary. Tall and slender, his gray hair was closely cropped. He wore all natural fibers: brown wool pants with a razor pleat, a 100% cotton shirt - crisply white.
But if there was any doubt that Randolph was an iconoclast, an in-your-face boat rocker and has been practically from Day One, just call the Northwestern University Medical School Allergy Department and ask for a statement.
"The head of the department wishes to make no comment on Dr. Randolph or on his ideas" was the no-nonsense reply of an unidentified spokesperson for that department.
And this came more than 40 years after Randolph was ousted from Northwestern. He was dismissed as a crackpot and formally charged as a "pernicious influence on medical students," said Randolph, who seemed somehow ironically proud of his ouster, a watershed moment in his career.
Randolph reflected on this and other events of his medical career during a luncheon where he was honored before his 1992 retirement. As he stepped to the podium, the 100 colleagues in attendance gave him a four-minute standing ovation.
Tears welled in the eyes of former patients, some of whom now work in one capacity or another in the medical profession.
After seeing more than 20,000 patients throughout a 60-year medical career, Randolph was there to formally announce his retirement from his practice.
With a personal history that began in rural Jerome, Mich., Randolph obtained his undergraduate degree from Hillsdale (Michigan) College and subsequently graduated from the University of Michigan Medical School. He later became a research fellow in allergy and immunology at Harvard Medical School and Massachusetts General Hospital in Boston. Randolph also founded the Allergy Clinic at Milwaukee Children's Hospital. Further affiliations included Lutheran General Hospital of Park Ridge and Northwestern University Medical School.
Other professional credits consist of writing or co-authoring three books plus co-founding a national medical society, the American Academy of Environmental Medicine (AAEM), formerly called the Society for Clinical Ecology.
Randolph has been called, "the most exceptional and outstanding physician in the entire field of allergy," by Doris J. Rapp, M.D., a Buffalo, New York, pediatric allergist and author of "Is This Your Child?"
Former patients lamented Randolph's retirement.
"I wish he could go on forever," said Barbara Grasser. She began seeing him in the fall of 1984.
"I'd been sick for 25 years with over a half dozen chronic illnesses," she recalled. Randolph put her in the hospital for a month and, according to Grasser, took her off all of the numerous medications she'd been taking. "Most of which were making me sicker," she said. Within a year of Grasser's first visit with Randolph, she had "learned how to live within my limits," avoiding the substances to which she was allergic and today considers herself completely recovered.
Former patient Wendy Swierbinski began seeing Randolph in the late 70s. She, too, was "suffering from a number of chronic complaints." Swierbinski was so pleased and impressed with Randolph that up until Randolph's retirement, she worked in his office as a patient educator.
Randolph was proud of his achievements, but the wounds inflicted by Northwestern still stung over 40 years later.
Revealing the depth of those feelings, Randolph referred to Northwestern University Medical School as, "a miserable institution in which nobody had any freedom of expression. If your opinions didn't echo those of the department head, you were ostracized."
Clearly his opinions did not echo those of that department head. Nor did they reflect the views of any department head at any of the six major medical schools in the United States in 1949. Just what did Randolph do that was so seditious that one after another of his colleagues in the medical establishment denounced him?
"I simply listened," he said. "I listened to my patients."
Randolph said that, during his medical training at the University of Michigan, he had been taught to take a medical history of each patient. There was a caveat, however that rubbed him the wrong way.
"You will learn sooner or later," an instructor advised him, "that the more numerous a patient's complaints, the less the significance of any of them." The message was that every patient with multiple complaints was either hysterical, neurotic, a hypochondriac or starved for attention. A good doctor didn't waste his time on them. "I felt that his basic technique of taking down only that information which he believed to be important was erroneous," Randolph said.
And after more than 60 years, he still took a, "dim view of this doctor's medical ability. "It occurred to me that if I recorded only what I knew from past experience and training to be important, I might be equally misinformed 10 years later," Randolph said.
An excellent typist ("I've typed faster than every secretary I've ever had," he said), the young doctor developed a technique not unlike a court reporter, where he took down everything a patient said. It was not unusual for a patient's file to contain more than 100 typewritten, single-spaced pages of text. "I listened to every word my patients said. I never saw a patient that I didn't take down every detail of their life/medical history verbatim," Randolph said.
By going over this detailed history, Randolph said he could see trends and relationships that would reveal clues as to the origin of the patients' complaints.
As he turned his attention to his patients, Randolph began to tune out his colleagues' definition of allergy, a relatively new medical specialty, having developed in the early 1900s. In those days, allergy was defined simply as "altered reactivity over time," Randolph said, which meant that a substance could produce a reaction in one person while producing no such reaction in others. As the new field began to seek greater credibility among other, more scientific medical specialties, the definition of allergy was changed. The new interpretation restricted the definition of allergy to reactions that took place only within the immune system. This appealed to fledging specialists because these reactions were more scientifically measurable.
According to Randolph, this newer, immunological definition was constrictive because it was based on bodily mechanisms of reaction. He felt this definition was erroneous because it was clear, through documented tests, that 94 percent of instances of allergy to foods and all instances of allergy-like responses to environmental chemicals cannot be treated immunologically.
Randolph was not the only one who questioned the immunological definition of allergy. Predecessors included the likes of Dr. Arthur F. Coca, of Cornell University, and noted food allergist Herbert J. Rinkel, who were tolerated within the field so long as they kept a low profile. Randolph, however, was a very vocal thorn in the side of a very new field scrambling for credibility.
Earon Davis, a lawyer who has a master's degree in public health, was a longtime Randolph friend and an environmental health consultant in Evanston. Davis said, "As a medical field, allergy did not traditionally attract the best and brightest out of medical schools. The new discipline was still grappling with the need to be respected when Dr. Randolph entered the profession."
Even the hint of something then viewed as, "unscientific as Randolph's methods were seen as challenging to the established community of doctors," Davis said.
Davis, who referred to Randolph as "the grand master in the field of allergy," said that Randolph's ideas challenged a few strongly held precepts. As a teacher at Northwestern, he shared his views with his students and thus came into "head-to-head combat with a conservative and cautious department head," Davis said. Add to that the fact that Randolph was a prolific writer, constantly seeking publication of his findings. "Since medicine was no different from any other field, and ego involvement abounds, their first instinct was to silence this `lunatic,' " Davis said.
Indeed, Northwestern's first move was to ask Randolph not to affiliate himself with them on his writings. When that failed to silence him, he was "excommunicated," to use Randolph's word. Randolph recalled the incident that immediately precipitated his ouster in 1949.
"I began seeing psychotic and behavioral reactions that were obviously allergic reactions in the broader (non-immunological) sense of the word and began diagnosing hyperactivity in children, and psychotic responses in others as linked with allergy," Randolph said. "I took motion pictures of how I could induce a psychotic reaction in one patient who was sensitive to beets and beet sugar. She became psychotic after she ate them when she hadn't had them for a week. She didn't know where she was, who she was or what day it was."
When Randolph showed the movie at a staff meeting, another medical professor declared that the woman was clearly hysterical, and her condition had no relationship to Randolph's alleged allergic response to beet sugar. The implication that the patient was simply performing according to his expectations due to Randolph's suggestion was more than Randolph could tolerate. In his book "An Alternative Approach to Allergies," Randolph refers to this attitude as a pervasive distrust of the patient in the medical profession. He said physicians have "a suppressive orientation, demonstrated by their use of synthetically derived drugs.
"Synthetically derived drugs completely mask the symptoms of the real illness and don't address the cause. They are used to stop the patient from bellyaching. I use the bellyaching patient to find out why they're bellyaching. I use no drugs at all."
This point of view was echoed by Dr. Charles T. Hinshaw, president of the American Academy of Environmental Medicine. He referred to Randolph as a, "progenitor of a whole new field" called clinical ecology, also environmental medicine, which was the study of how biologic systems function as they interact with environmental stressors.
Randolph credited many early influences with his ultimate choice of medical specialty. But colleague Ralph W. Moss also credited Randolph's early family influences as well with a kind of life orientation. In the introduction to their jointly written book, he called Randolph, "a self-directed thinker to an unusual degree. This strength was often combined with a healthy American contempt for the authorities."
Two incidents in particular from Randolph's childhood stand out in his memory as harbingers of not only his professional pursuits but also of how he would come to approach issues and challenges.
Randolph was the third of six children born to cattle feeder Fred Randolph and his wife, Rena, a former schoolteacher. The family home was in Jerome, some 10 miles south of Jackson, Mich., and the cattle farm was up in midstate Gladwin County. Randolph worked with his father to drive the cattle up to the ranch each spring. The route took them past the Dow Chemical Plant in Midland. He remembers the strong chemical odor, so strong it surpassed even the cattle smell. This served as "a topic for a spirited soliloquy for the next several miles" for the elder Randolph, a man not given to keeping his opinions to himself, his son said.
The second incident, when Randolph was 11, involved an outbreak of hoof-and-mouth disease, which resulted in the destruction of all of the Randolphs' livestock, including family pets. That, coupled with a subsequent protracted state-imposed quarantine, nearly bankrupted family coffers.
With these incidents long behind him, Randolph went off to nearby Hillsdale College to become a psychiatrist. He gave this up in favor of medicine before graduation since he believed the field lacked a "scientific, rational way" of handling psychiatric cases. He entered University of Michigan Medical School, where his medical career got off to an inauspicious start with his very first patient.
He wrote in one of his books: "An aged cardiac male was propped up in a semi-reclining position in bed to be examined. I propped him up further to listen to the back of his chest, while my associate listened to his heart. I commented, `I don't hear anything anymore, do you?' He said, `No.' Whereupon we called the intern, who pronounced our first patient dead. A student nurse added to the indignity of this disaster by charting: `Patient died while being examined by junior medical students.' "
Convinced his future could only go up from this point, Randolph stayed with medicine, convinced he had something of value to bring to the field.
Two years later, Randolph was working with a patient who suffered a laundry list of symptoms with no clearly visible cause. She was a white woman in her mid-30s married to a black physician. Because of her interracial marriage, "she had been completely ostracized. According to the pre-conceived ideas of many doctors, she had every reason to be chronically sick," Randolph said.
Eventually, Randolph diagnosed her ailments as allergies/sensitivities to the combustible properties of oil, gas, coal and other chemicals. The diagnosis came 10 years before Rachel Carson published "Silent Spring," which broadly publicized the health risks posed by an increasingly chemical-laden environment. According to Davis, Randolph's diagnosis showed how he was clearly years ahead of his time.
"The current relevance of his findings in terms of the likes of the Du Page County (Illinois), returning Desert Storm veterans, the sick-building syndrome and so on, plainly shows him to be an exceptional figure in modern medicine," Davis said. "That he achieved his stature in the face of incredible opposition also speaks volumes for Dr. Randolph's character." Indeed, Randolph often talked about the organized opposition he met, but that opposition was not isolated to the medical community.
Davis said that Randolph managed to antagonize the food industry (primarily producers of grains, eggs and milk) with his theories on food allergies. He took on the billion-dollar petrochemical industry with his theories on chemicals and their effect on individual health. And then there was the multi-billion-dollar pharmaceutical industry, which came face to face with Randolph and his views on the cause and treatment of many psychoses, including hyperactivity.
Thus, Davis said, the forces Randolph confronted and others like him will continue to confront - AAEM boasts nearly 600 members nationally - are political, legal and social as well as medical. But Randolph, whose own personal life was not without adversity (he suffered from chronic recurrent lung collapse, macular degeneration claimed much of his eyesight and his wife of 40 years suffered from Alzheimer's disease), believed he had shown what can be accomplished.
Randolph was not a rich man. His independent, labor-intensive methods were not conducive to accumulating wealth, but he headed a medical foundation that helps fund further research in his field. He was proud of the fact that no corporation had taken his foundation as a charitable cause, but instead it was funded wholly by individuals who believe in what he has done.
Davis, in introducing Randolph to his colleagues that sunny day when he announced his retirement, quoted 19th Century biologist Thomas Huxley: "Sit down before Mother Nature as a small child. Be prepared to cast aside all preconceived notions and to follow her into whatever abyss she leads, or you shall learn nothing."
An apt observation, Davis said, on the life of Theron Randolph.