Toward the end of his undergraduate days at Oberlin College in 1970, Luther K. Robinson, the son of a Ford plant worker and a hospital housekeeper, who planned to go to medical school, was given "the talk" by one of his professors.
"He said to me, 'Do you know that it's hard to get into medical school?' " Robinson recalled. "I told him yes, I knew that. He said, 'You're not the strongest student in the division.' I said I knew that, too. He asked me, 'What are you going to do if you don't get in?' I told him that I was going to get in. He asked me how I knew that. I told him, 'Well, I'm going to be a doctor, and if I'm going to be a doctor, then I'm going to have to go to medical school.'"
Robinson's determination to pursue medicine has served him well. Earlier this month, the professor of pediatrics at the University at Buffalo School of Medicine and Biomedical Sciences and the Division of Genetics at Women & Children's Hospital of Buffalo was honored with the 2013 Excellence Award of the National Organization on Fetal Alcohol Syndrome in Washington, D.C.
He was recognized for his career-long dedication to studying and screening children for fetal alcohol syndrome, advocacy for better support for patients and the prevention of FAS. In addition to his clinical practice, he has an active research program, funded primarily by the National Institute on Alcohol Abuse and Addiction. With national and international collaborators, he has conducted screening and longitudinal studies of children with FAS in the U.S., Africa and Europe.
After graduating with his medical degree from the University of Cincinnati College of Medicine in 1974, Robinson served in the U.S. Public Health Service in San Diego and then did his residency in pediatrics at the University of California, San Diego. His plan was to go into private practice. But then came his rotation with Kenneth Lyons Jones, considered the father of the field of FAS, first identified in 1973 by Jones and his mentor, David W. Smith at the University of Washington.
"Jones is an incredible teacher, who really invests in his trainees," Robinson said. "That rotation changed the way I viewed my career."
He held a postdoctoral fellowship in dysmorphology (birth defects that lead to physical disabilities) under Jones and then became assistant professor of pediatrics at the University of Texas Medical School at Houston.
Robinson, who is board certified in pediatrics and clinical genetics, was interested in birth defects and how a mother's health affects the baby, particularly in the minority community.
"One of the doctrines of the practice of medicine is that early recognition improves outcomes," he said. "I wanted to help provide better recognition of genetic and environmental disorders, especially in underrepresented populations. The data suggest that FAS is more prevalent among minorities, but this is a preventable birth defect."
In 1987, he took an assistant professor position at UB and at WCHOB, attracted by what he recognized as the university's longstanding and nationally recognized tradition of clinical excellence in the department of pediatrics.
"I thought Buffalo was going to be a blip on my CV," he noted, smiling. "I've been here 26 years."
Robinson is director of dysmorphology and clinical genetics at WCHOB; he works with other genetics professionals to meet the diagnostic and treatment needs of patients with known or suspected prenatal exposures to neurotoxic substances, such as alcohol.
Since he began studying FAS, he said the number of cases, roughly 1 in every 1,000 live births in the U.S., has either stayed constant or seen a slight increase. The rate is especially high in poor urban and poor rural populations, he said.
"We've known about fetal alcohol syndrome since 1973, but people get mixed messages," he said. "They'll hear: 'Have a glass of wine when you're pregnant, it'll relax you,' or 'Dark beer is good for your milk.' But there is no safe level of alcohol consumption during pregnancy. The recommendation is: Just don't drink during pregnancy. Period."
Fetal alcohol syndrome is a recognizable constellation of birth and developmental disabilities, including small stature, slight build, small eyes and smaller than normal head circumference. Additional physical symptoms include improper development of the space between the nose and upper lip.
But by far, the most detrimental result of fetal alcohol syndrome is that it causes improper development of the nervous system, leading to lifelong learning and developmental disabilities.
"It's not glaringly obvious which children have fetal alcohol syndrome," said Robinson, although specialists can usually identify them by their facial characteristics. "These are kids who are often described as willful, impulsive, hard to manage. They are told by teachers and administrators that they just have to work harder in school. But with fetal alcohol syndrome, there has been an insult to the developing brain that leads to these problems."
Treatment for fetal alcohol syndrome is largely focused on school and behavioral support for the child, including physical, speech and occupational therapy provided by the New York State Department of Health. Robinson's division at WCHOB also works closely with a support group for parents.
When diagnosing a patient, Robinson tells the mother that alcohol crosses the placenta and can harm the baby. "I try to depersonalize and destigmatize the birth mother," he said. "Both the child and the mother are in need of intervention. Sometimes, the recognition of the child's birth defect will get the parent to change her behavior."
However, most of the time, the caregiver Robinson is dealing with is not the birth mother.
"In clinical practice, 90 percent of children diagnosed with fetal alcohol syndrome are in foster or adoptive care," he said. "That statistic just underscores the disruptive effect of alcohol."
Robinson was an inaugural member of the Collaborative Initiative on Fetal Alcohol Spectrum Disorders funded by the National Institute on Alcohol Abuse and Alcoholism. He has also worked with the New York State Department of Health Congenital Malformations Registry in tracking the prevalence of birth defects.