One of the most persistent myths is one that’s been particularly and doggedly resistant to evidence, science, clinical trials, epidemiology, and reason. It’s also a myth that I’ve been writing about a long time. Specifically, I’m referring to the now scientifically discredited myth that the mercury-containing thimerosal preservative that used to be in quite a few childhood vaccines causes autism. The myth began in the late 1990s and was later fed by the publication of David Kirby’s book Evidence of Harm, which was basically a paean to various brave maverick doctors who promoted the claim that mercury in vaccines cause autism. Among the “scientists” promoted by David Kirby were the father-son team of Mark and David Geier. Mark Geier is a physician who also has a PhD and represents himself as a medical geneticist; his son David has no medical degree, leading to my wondering from the very beginning how it was that he got away with helping his father evaluate and treat autistic children, in essence practicing medicine without a license.

The Geiers are most infamous for their “Lupron protocol,” which I first learned about back in 2006. As I wrote about it in 2009, when the mainstream media finally noticed the Geiers’ dubious medicine and how they were franchising it to different states, it was chemical castration for autism. The short version is that, somehow some way, Mark Geier got the idea in his head that testosterone contributes to autism. That in and of itself isn’t woo, given that scientists have from time to time hypothesized that very thing. What made the Geiers’ conclusions pseudoscience is their explanation. Basically, Geier claimed that testosterone binds mercury from vaccines, making it more “toxic” to the brain and also making it harder to get rid of the mercury using chelation therapy. Never mind that the only paper showing testosterone binding to mercury did it in benzene (hint: your blood is not benzene) under extreme conditions. What was worse, however, was the Geiers’ “solution” to this problem, which was to add to the autism quackery known as chelation therapy another potentially harmful form of quackery, namely chemical castration using Lupron, a drug that shuts down the production of sex hormones, including testosterone. It’s a drug that’s used to treat metastatic prostate cancer, a treatment that replaced the old treatment for metastatic prostate cancer, namely surgical castration. (Not coincidentally, it’s also used to chemically castrate sex offenders.) Even worse still, the Geiers somehow got away with a highly unethical clinical trial in which they packed the Institutional Review Board overseeing it with their cronies, going merrily on their way offering an unethical “clinical trial” untouched and seemingly untouchable.

Finally, the law acts

For over five years now, I’ve been wondering just how in the world the Geiers got away with such unethical pseudoscience and how they got away with it for so long. I couldn’t figure it out. Not only did they ply their dubious medicine on autistic children, but David Geier appeared to be functioning as a “diagnostician,” somehow fooling the State of Maryland’s Autism Commission into appointing him as a member, even though he completely lacks expertise to be practicing medicine and does not have a medical or clinical degree of any kind. Meanwhile, evidence suggested that the Geiers appeared to be playing fast and loose with insurance companies by making lots of diagnoses of “precocious puberty,” a very uncommon diagnosis. Truly, I wondered what was wrong with the State of Maryland…until last week, when online acquaintances, not to mention some of you started sending me the news that Mark Geier has had his medical license suspended by the State of Maryland, as outlined in this 48-page court order. Kathleen Seidel, as usual, is already on the case as well.

Yes, the Maryland State Board of Physicians has finally acted. All I can say is: It’s about time. Let’s take a look at some of the relevant sections of the order. First, here’s the money section, namely the summary statement, which I cite nearly in its entirety:

The Respondent misdiagnosed autistic children with precocious puberty and other genetic abnormalities and treated them with potent hormonal therapy (“Lupron Therapy” or “Lupron Protocol”), and in some instances, chelation therapy, both of which have a substantial riskof both short-term and long-term adverse side effects. The Respondent’s treatment exposed the children to needless risk of harm.

The Respondent, in addition to being a physician, is certified as a genetic counselor. His assessment and treatment of autistic children, as described herein, however, far exceeds his qualifications and expertise. The extensive and extensive batteries of laboratory studies the Respondent initially orders, many of which he orders to be repeated on a monthly basis, are outside the standard quality of care for a work-up for an autistic patient or to determine the underlying cause of autism. The Respondent failed to conduct adequate physical examinations of any of the patients and in several instances, began his Lupron Protocol based merely on a telephone consultation with the child’s parent and the results of selected laboratory tests he ordered. The Respondent’s omission of a comprehensive physical examination constitutes a danger because his treatment is based on a diagnosis that requires documentation of sexual development beyond that expected for the age of the child. Moreover, his treatment may constitute more of a risk to a child with an underlyingl medical condition.

The Respondent failed to provide adequate informed consent to the parents of the autistic children he treated. In one (1) instance, he misrepresented that his treatment protocol had been approved by a federally approved IRB.

[...]

The Respondent endangers autistic children and exploits their parents by administering to the children a treatment protocol that has a known substantial risk of serious harm and which is neither consistent with evidence-based medicine nor generally accepted in the relevant scientific community.

In the order, Mark Geiers’ numerous other offenses are listed, including his corrupt, crony-packed IRB overseeing his clinical trial, possible insurance fraud (billing insurance companies for services never rendered), failing to obtain informed consent, misdiagnosing children with “precocious puberty” in most egregious ways (such as diagnosing children who did not meet the age criteria for precocious puberty) and writing medical necessity letters based on this mistaken diagnosis, and misrepresenting himself as a geneticist. Basically, regarding this latter charge, Mark Geier claimed to be a geneticist, which is a “physician who evaluates a patient for genetic conditions, which may include performing a physical examination and ordering tests,” even though he is not a medical geneticist; rather, he is a genetic counselor, which is “an individual with a master’s degree who helps to educate the patient and provides an assessment of the risk of the condition recur in the family.” I know genetic counselors. I work with genetic counselors. They don’t diagnose genetic conditions; rather, they counsel patients after either a genetic diagnosis has been rendered or the patient has developed a condition (such as breast cancer at a young age) that might indicated a genetic predisposition to a disease. It turns out that Geier also misrepresented himself as a board-certified epidemiologist when he is not.

Particularly disturbing are the treatments to which Mark Geier submitted children in his care. Case studies described in the report include include a battery of over 40 tests, spironolactone for misdiagnosed hyperaldosteronism, chelation therapy for “heavy metal toxicity,” Lupron, and methyl B12 drops for unclear and undocumented indications. One patient, patient F, a female, was given Femara, an aromatase inhibitor, which is used to treat estrogen receptor-positive breast cancer. It’s used mainly in post-menopausal women to shut down hormone production in the peripheral tissues. (It doesn’t work in premenopausal women because their ovaries make lots of estrogen, far more than the small amount made in peripheral tissues.) The presumed rationale, I have to guess, would be the same as in younger woman with breast cancer, where sometimes it is necessary to shut down ovarian hormone production and then to top it off by shutting down peripheral hormone production. My guess is that Geier somehow thought he needed to shut down not just ovarian sex hormone production in this girl but peripheral production as well. Why, I have no idea, but its profoundly idiotic and potentially harmful, particularly when combined with chelation therapy. Meanwhile, in other patients, Mark Geier proposed adding another anti-androgen drug, Androcur.

The abuse of autistic children was staggering. As a result, the Board made a finding of law:

Based on the foregoing facts, the Board concludes that the public health, safety or welfare imperatively require emergency action in this case, pursuant to Md. State Gov’t Code Ann. § 10-226 (c) (2) (i) (2009 Repl. Vol.).

That’s right, not just action but emergency action. I guess the State of Maryland has a different definition of “emergency,” given that the Geiers have been at this for at least six years, but I’ll take what I can get. At least when finally roused from its torpor, the Maryland State Board of Physicians recognized the Geiers for the threat to autistic children that they are and, as a result, ordered that Mark Geier’s license to practice medicine in the State of Maryland be summarily suspended. As a result, Mark Geier was required to surrender the following to the Board:

• his original Maryland License D24250
• his current renewal certificate
• his Maryland Controlled Dangerous Substance Registration
• all controlled dangerous substances in the Respondent’s possession and/or practice;
• all Medical Assistance prescription forms
• all prescription forms and pads in the Respondent’s possession and/or practice
• any and all prescription pads on which his name and DEA number are imprinted

Excellent.

I only have a couple of remaining questions. First, what will be the response of the anti-vaccine movement. One thing I’ve noticed over the last couple of years, since the mainstream media first noticed his Lupron protocol is that the anti-vaccine movement seems to have distanced itself from the Geiers. They’re almost never mentioned anymore on Age of Autism these days, even though they used to be regular features there a couple of years ago. They’re not the headliners at the yearly Autism One quackfest anymore; they are, however, still listed as speakers for this year’s quackfest. One has to wonder whether they’ll be quietly disinvited now that Geier has had his medical license yanked, or whether Lisa Sykes will remove the Geiers’ epilogue from her book. Probably not, I’d guess. Most likely the Autism One organizers will see the loss of Mark Geier’s medical license as evidence of his cred as a “brave maverick doctor,” much as Wakefield’s cred remains high in the anti-vaccine movement. Even so, in the several days since the suspension of Geiers’ license became widely known, I’ve seen almost nothing written about them by the anti-vaccine movement, which is in marked contrast to the wailing and gnashing of teeth observed after Andrew Wakefield lost his medical license in the U.K.

Be that as it may, I’m now left wondering how long it will be before the conspiracy theories come out. The most obvious one hasn’t hit the blogosphere yet, at least not as I write this. How long do you think it’ll be before an anti-vaccine loon claims that stripping Mark Geier of his medical license (just like another brave maverick doctor, Andrew Wakefield!) was a plot by the miltiary-industrial-pharma-CDC complex to distract attention from the case of Poul Thorsen. You know it’s coming sooner or later.

Finally, what of the metastatic deposits of Geier père et fils quackery in other states? After all, besides Maryland, the Geiers have spread their clinics to Kentucky, Missouri, Florida, Illinois, and Indiana. Will these states now act to shut down the Geier clinics there, known as ASD Centers, LLC? I know I’ve complained about how long it took the State of Maryland to do the right thing. Even so, I’m glad that the Board there finally acted. It’s time for the medical boards in these other states to do likewise.

Fallout

There was one truly odd aspect about this incident, as long overdue as it was and as happy as I was to learn about it. Basically I learned something else along the way that I hadn’t known. In fact, I was pretty shocked to find this out, and I wanted to know how something like this could possibly have happened. I’m referring to the fact that Mark Geier’s son David Geier had somehow slimed his way onto the State of Maryland Commission on Autism as a “diagnostician.” As I pointed out at the time, David Geier is not a physician and has no qualifications to diagnose or treat autism (or anything other medical condition, for that matter). Not that that’s stopped him thus far; he does it anyway.

By way of the Baltimore Sun, I now learn that part of the fallout in the aftermath of Mark Geier’s humiliation is that, not only is the state trying to get rid of David Geier but people are asking–shall we say?–inconvenient questions about how he was appointed to the Commission on Autism in the first place:

A day after Dr. Mark Geier’s medical license was suspended in Maryland over allegations of putting children with autism at risk, state officials were seeking to remove his son from a state commission that advises the governor on the disorder.

The officials were also struggling to explain why David Geier, who has an undergraduate degree in biology and does not have a medical license, was identified by the Commission on Autism as its “diagnostician.” The commission’s website had listed him as a doctor until Wednesday, which officials said was a clerical error. The commission’s listing also includes the Geiers’ company, ASD Centers LLC, whose website lists a corporate center in Silver Spring but is not registered in Maryland.

“Under the circumstances, we do not believe it’s appropriate for David Geier to serve on the autism commission,” said David Paulson, a spokesman for the state Department of Health and Mental Hygiene, which submitted 19 names to the governor, including David Geier’s, for approval to the panel. “Unfortunately, he declined to resign his commission. … As a result, we are considering the appropriate next steps.”

Leave it to a Geier not to take the hint when not wanted, leading the state to try to get rid of him. Like father, like son, I suppose. However it is a very interesting question. How could someone like David Geier, a man with no qualifications, associated with pseudoscience like the Geiers’ Lupron protocol get on such a panel? While it’s true that he has been caught in the past inflating his credentials, I doubt that explains it. The explanation coming from the Department of Health and Mental Hygiene doesn’t sound particularly convincing:

Paulson said the state was aware of “the controversial nature of David Geier’s views” when he was recommended for the position on the commission, which was formed by the legislature in 2009. But officials were looking for a “diverse” panel.

“Controversial.” You keep using that word. I do not think it means what you think it means. David Geier’s views are most definitely not “controversial,” at least not from a scientific standpoint. They’re demonstrably wrong. They’re pseudoscientific. They’re advocacy of abuse of autistic children. But controversial? Not so much. One potential explanation for David Geier’s presence on the panel has been suggested by Robert Goldberg, author of Tabloid Medicine: How the Internet is Being Used to Hijack Medical Science for Fear and Profit, who asks how an autism quack got on the Maryland autism panel and then tries to answer the question:

Here’s a clue: The Geiers did have their association with John L. Young, MD.

Who is Dr. Young and why might he be connected to David Geier’s appointment?
In 2009, Dr. Young “was the President of the Montgomery County Medical Society, the largest component medical society in Maryland. From 2007 to 2009, he was asked by Maryland Governor Martin O’Malley to serve as a Commissioner for the Maryland Community Health Resources Commission, and in 2009, was appointed by Governor O’Malley to serve on the Board of Regents for the University System of Maryland.”

That information is taken from the website of ASD Centers, which the Geiers set up to peddle Lupron and other dangerous and disproven autism treatments. That’s because John L. Young, MD — founded in 2008 — along with Mark Geier — ASD Centers.

http://www.autismtreatmentclinics.com/Staff.html

And there’s more: The Geiers set up an Institutional Review Board (IRBs are established to review the impact of clinical research on human subjects) to approve their own research, conducted by ASD Centers of course. The IRB called the Institute for Chronic Illnesses turned out to be Mark Geier’s home.
More problematic, John Young was a ‘co-investigator’ with Mark and David Geier in their Lupron research.

Even worse, Young was also a member of the IRB.

http://www.neurodiversity.com/weblog/article/98/

It certainly does look suspicious, doesn’t it?

Whether Dr. Young is the conduit through which David Geier managed to find a seat on Maryland’s autism panel or not, the Geiers have built a virtual “autism biomed” empire in Maryland, Illinois, Indiana, Texas, Florida, New Jersey, Missouri, Kentucky, and Washington based on, in essence, the chemical castration of children. We have to remember that Geier’s only been shut down in one state. True, it’s the state of his current residence, which is huge, but that doesn’t stop the Geiers from simply relocating to one of the other states in which Mark Geier holds a medical license. Heck, if Dr. Geier were to relocate to Virginia, he might not even have to move out of his very large, very expensive home; he could just deal with a longer commute. The problem, as I’ve discussed before, boils down to ineffective state medical boards, many of which are overburdened and hampered by laws that mistake giving doctors due process with viewing a medical license as a right. It’s not; it’s a privilege. In any case, the ineffectual regulation of physicians by many state medical boards have allowed “unconventional” doctors like Rashid Buttar to continue their dubious medicine with impunity, in essence thumbing their noses at the medical establishment.

Which is what the Geiers are still doing in Illinois, Indiana, Texas, Florida, New Jersey, Kentucky, and Washington.

So, how to stop them? In most states, for the medical board to act, there have to be complaints, either from patients or fellow health care professionals. Whether there have been complaints about the Geiers or not, I don’t know, but there should be. Also, a license suspension in one state can trigger an investigation in another state. At the very least, the Mark Geier will have to report it the next time he applies for renewal of his license in the several states in which he is licensed, a convenient list of which has been kindly provided here.

I have two hopes right now. The first, and lesser, of the two is that David Geier will be kicked off of the Maryland Commission on Autism. He should never have been on that panel in the first place, and it would be very, very interesting to find out exactly who pushed for his appointment, given that the competition for the spots on that committee was pretty fierce. I highly doubt that David Geier got a spot on the committee on his merits; almost certainly someone somewhere pulled some strings, possibly Dr. Young. The second, and more important, hope is that the State of Maryland’s action, as long overdue as it may have been, ultimately cascades, and Mark Geier finds himself losing his medical license in each and every state in which he holds one.

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