Suspension of Mark Geier is upheld

19 Apr

Mark Geier is a name well known in the autism world of alternative medicine as well as a major source of papers purporting to link autism to mercury. He had a medical practice, was licensed in multple states, presented repeatedly at autism parent alt-med conventions, and served as a witness for the vaccine court.

Mr. Geier’s license to practice medicine was suspended last year. Since then he has tried a few avenues to get his ability to practice reinstated, at least while he is pursuing appeals. The Maryland State Board of Physicians has denied his request and issued a (second) cease and desist order informing him to stop practicing medicine.

Mr. Geier and his son, David Geier, took a theory from Prof. Simon Baron-Cohen: the “extreme male brain” concept of autism. Where Prof. Baron-Cohen focused on the effects of fetal testosterone levels on brain development, the Geier team somehow arrived at the idea that autistics have mercury bound in to testosterone in their brains. One can read an analysis of this theory at A Photon in the Darkness, Miscellaneous Mercury Nonsense. As you can imagine from the title of that article, the autism/mercury/testosterone idea was an obviously bad idea from the start.

Unfortunately, the Geiers took this bad idea from theory to practice. They further hypothesized that these mercury/testosterone sheets prevented chelators from removing the mercury. So, they futher hypothesied, by reducing the amount of testosterone in the body, the mercury bound in these supposed mercury/testosterone sheets would be released allowing chelators to remove the mercury. Why lower levels of testosterone would lead to these supposed mercury/testosterone complexes breaking down is not well explained. Which is another way of saying it doesn’t make sense.

It is worth noting that these sheets, or matrices as the Geiers dubbed them, of mercury and testosterone do exist. In laboratories. After boiling mercury compounds in beakers of benzene. As Prometheus wrote back in 2006:

This is not a condition even remotely similar to anything found in living tissue – of any vertebrate species. In other words, it isn’t likely to happen in autistic children unless you dissolve them in hot benzene.

Basically every link in their logic chain was bad. But this did not stop the Geiers from applying Lupron as a treatment. The drugs for reducing testosterone production (such as Lupron) are expensive. Insurance doesn’t pay for Lupron to reduce testosterone levels in disabled children so that non-existent mercury/testosterone sheets will break down by some unexplained mechanism so that chelators can remove the mercury which is not really linked to autism. Probably because of the insurance angle, the Geier’s prescribed Lupron and similar drugs not for the supposed ability to help the chelating process, but to treat precocious puberty. Early onset of puberty.

According to the Maryland Board, based on records and testimony from patient’s parents, the Geiers failed to do the basic work involved in diagnosing precocious puberty and, in some cases, diagnosed precocious puberty in children who were old enough to be going through puberty.

Sound complicated? They were diagnosing precocious puberty without the proper tests in children who didn’t have it in order to prescribe drugs to reduce testosterone levels so that mercury/testosterone sheets which don’t exist in their brains will break down and allow a chelator to remove the mercury which doesn’t cause autism.

Lupron is not a mild drug. It reduces sex hormones and delays puberty. Children are supposed to go through puberty at a given time in their lives and delaying it comes at a cost. In addition the drug itself has side effects. From the recent decision upholding the suspension of Mr. Geier’s license:

Lupron treatment carries a very high risk of skin abscesses and infections, and it is contraindicated in patients with a history of seizures. Dr. Geier nevertheless prescribed it for Patient B, who had a history or uncontrolled seizures. Nor did Dr. Geier perform all of the necessary diagnostic procedures before prescribing Lupron. Nor did Dr. Geier physically examine Patient B until almost three years after he began prescribing for him. See Proposed Decision at 33, 37-38. This is only one example of the truly risky behavior that Dr. Geier engaged in with these patients.

Mr. Geier’s license to practice medicine was suspended last year by the Maryland Board of Medical Practice. He tried to defend himself in a series of actions since, with this action being the final word.

The Board “entirely agrees” with the a previous decision that allowing Mr. Geier to continue to practice medicine while awaiting the determination of formal charges raises the likelihood of serious harm to public health and safety:

The ALJ concluded that “allowing [Dr. Geier] to continue practicing medicine while formal charges are pending raises a substantial liltelihood of risk of serious harm to the public health, safety, or welfare.” The Board entirely agrees. For Dr. Geier to practice medicine at this time would constitute a danger to the patient community.(3)

The footnote (3) in the above statement was already quoted in this artice–look above to the paragraph on “Lupron treatment carries a very high risk…”

The Board repeated this position in their conclusion:

“I conclude that for all these reasons, the Patients’ health, safety or welfare was at risk of serious harm.. Further, the existence of all these problems throughout all the Records raises a substantial likelihood that the risk of serious harm to the Patients was also posed to many other children with autism treated by the Respondent. I find that this meets the necessary standard for summary suspension of the Respondent’s license: allowing him to continue practicing medicine while formal charges are pending raises a substantial likelihood of risk of serious harm to the public health, safety, or welfare,”

One very troubling argument made by Mr. Geier was that he was not required to have an Institutional Review Board for his research. One of the charges against Mr. Geier involved an IRB he instituted–where he, his son, his wife, a patient’s mother and other interested parties were members of the IRB. The Board did not address whether such a board was required, but did dismiss the charge based on the lack of evidence put forth by the State. More discussion on the IRB can be found at Neurodiversity.com in the article An Elusive Institute.

The Respondent argued both that he was not required by federal law to have an Internal Review Board and, that even if he was bound by such a requirement, the State failed to produce any evidence that his board operated in a flawed manner. The State did not dispute this argument in its response to the Motion. I agree with the Respondent that the State failed to produce sufficient evidence to survive a motion for judgment on the allegations related to an Internal Review Board. See COMAR 28.02.01.12E. C’ Md. Rule 2-519. I will recommend that this portion of the Motion be granted and further recommend that paragraphs 157 through 162 of the Order for Summary Suspension be dismissed.

The thought that somene (Mr. Geier in this case) believes that research could be performed on anyone, not just disabled children, without the protection of an IRB is frightening.

In what is to this reader the most ironic statement by Mr. Geier in this action:

Finally, Dr. Geier accuses the ALJ of establishing a new and unwarranted standard for the medical care of children with autism. Again, Dr. Geier fails to acknowledge that the ALJ relied to some extent on the testimony of his own expert witnesses, and on his own sworn statement, to make her findings regarding the standard of care and the deficiencies in Dr. Geier’s practice.

Yes. Dr. Geier accuses the ALJ of establishing a “new and unwarranted standard for the medical care of children with autism.” Mr. Geier, who while he may not have been the first to promote chelation for autism has been one of the primary proponents, Mr. Geier is part of the team who invented the idea of Lupron as a part of a chelation protocol. A “new and unwarranted standard for medical care of children with autism”.

In addition to this decision, and the cease and desist order, Mr. Geier’s licenses to practice have been suspended in California, New Jersey, Indiana, Florida, Ohio, Washington and Virgina.

The Maryland Board accepted James Adams (a materials scientist) as an expert on chelation, at the behest of Mr. Geier. The opinions offered by Mr. Adams differ from those of medical toxicologists (a group of physicians trained and in practice to treat poisoning):

The Respondent [Geier] testified in his sworn statement that he orders chelation therapy for hispatients on “various” schedules “every other day or a few days on and a few days off for a couple of months – three months.” State’s Ex, 8 at 34. Yet, the Respondent’s expert on chelation, Dr. Adams, testified credibly that patients need an even longer break between rounds of chelation: three days of chelation followed by eleven days off. Dr. Adams also testified that chelation therapy should only be initiated after a patient is given a short “challenge” dose of chelation to ensure that the patient actually needs the therapy. If administered to a patient who does not need it, chelation poses serious risks of injury to the brain and other organs. It is imperative, therefore, that a physician only administer chelation on a limited basis to the patients who actually need it. The Respondent not only skipped the challenge step necessary to ensure chelation was even necessary, but then went full force into chelation therapy on an intensive schedule (with an experimental drug.not FDA-approved for that purpose) without appropriate rest breaks. In several cases, moreover, the Respondent failed to regularly monitor the effects of chelation, and in two cases he prescribed it for patients that he knew he could not monitor.

The concept of a “challenge test” for diagnosing mercury intoxication is covered by the American College of Medical Toxicologists in American College of Medical Toxicology Position Statement on Post-Chelator Challenge Urinary Metal Testing. Who concluded:

“It is, therefore, the position of the American College of Medical Toxicology that post-challenge urinary metal testing has not been scientifically validated, has no demonstrated benefit, and may be harmful when applied in the assessment and treatment of patients in whom there is concern for metal poisoning.

I hope that the Maryland Board looks into this issue of challenge testing before ruling again on such issues.

Mr. Geier is scheduled to give a talk at a large annual autism-parent convention. Last year, after the first action suspending his license, he was reportedly given a standing ovation at this convention. This reader is at a loss to understand why.

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10 Responses to “Suspension of Mark Geier is upheld”

  1. Vincent Iannelli, MD April 19, 2012 at 02:50 #

    He will always have Texas, or so it seems.

    Despite the rules for holding a license in Texas that he is breaking, including the fact that his physician profile doesn’t list his disciplinary actions by all of those other states, and that you are not supposed to be “the recipient of a previous disciplinary action by any other state or jurisdiction,” it doesn’t seem like they have done anything to him.

  2. autiemum April 19, 2012 at 07:40 #

    The mystery to me personally is how he was able to do it for so long. I hope that the post NHS medicine coming to the UK doesn’t allow it to happen here

  3. MikeMa April 19, 2012 at 16:58 #

    Justice has moved glacially but in the right direction here. IMHO, Mr Geier should have a restraining order keeping him far away from patients.

    There are other issues here as well. His son, who was never a doctor, was alleged to be treating patients. Has that claim been adjudicated, dropped or is it still pending?

    Also, in the above synopsis, it says that Geier wanted to use Lupron to chelate mercury. As pointed out, this idea was flawed at every step but Geier had to claim precocious puberty in order to bill insurance for a treatment they would otherwise decline coverage. Is that alleged insurance fraud still pending?

    I do hope he & his son serve time and pay restitution.

  4. David N. Brown April 19, 2012 at 18:08 #

    There’s one major weakness in the Geiers’ “theory” that I haven’t seen discussed: the supposed association of autism with elevated testosterone. Given the common observation that autistic children are LESS physically strong and well-developed than their peers, this proposition was about as counterintuitive as finding elevated insulin in a diabetic (which actually CAN happen!) That didn’t mean the Geiers were wrong, but it did mean they would have had to produce a lot of evidence to convince their peers of the theory, never mind the soundness of a treatment based on it.

    A striking aspect of the Geiers’ self-justifications is prominent mentions of (to put it VERY delicately) “body exploration”. This only makes it all the more clear that their idea of “premature puberty” was indistinguishable from what any real authority would consider “normal” and healthy development. But, it is equally clear that the Geiers were able to appeal on a very fundamental level to panicked and puritanical parents.

    David N. Brown
    Mesa, Arizona

  5. Todd W. April 19, 2012 at 18:43 #

    @MikeMa

    David Geier has been charged by the MD Medical Board with practicing medicine without a license. Not sure where that stands currently.

    While I think that it is great that justice is being done with regard to the Geiers, has anyone heard of any actions against any of the other physicians/employees of their centers around the U.S.?

  6. Michelle April 19, 2012 at 19:56 #

    I am embarrassed to say that Missouri has yet to take action against this charlatan, who is still operating in surburban St. Louis. I don’t know if he is currently seeing patients, but he has not been shut down.

  7. MikeMa April 19, 2012 at 21:46 #

    The last reference I can find on David Geier’s ‘practicing medicine without a license’ rap was from last summer. Surely something has happened since then.

  8. Anne April 20, 2012 at 04:39 #

    As Kathleen Seidel pointed out in her post, this has been a long process. According to the ALJ’s decision, the hearing lasted for several days in June 2011, and the hearings for the formal charges against Mark Geier (this was just the interim suspension) and for the charges against David Geier were scheduled to be heard in December 2011. The hearings may have taken place then, even if the decisions haven’t been issued yet.

  9. autiemum April 20, 2012 at 07:42 #

    I think David Brown’s point about “puritanical parents” is worth considering further. Sexual development and obvious sexual behaviour a child can be upsetting to any parent. It may be that the parents who took their children to Geier were particularly unable to cope with this aspect of their child. It’s very hard otherwise to see why they would be willing to interfere with this crucial aspect of development in such a drastic way. It’s like fearing your child was going to be too tall and cutting off their feet. It’s likely to be completely irreversible interference.

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  1. One for The Good Guys « An Autism Dad - November 6, 2012

    [...] Suspension of Mark Geier is upheld [...]

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