The other day, I wrote about how mercury militia general and autism quack extraordinaire Dr. Mark Geier had his medical license suspended by the State of Maryland. At the time, I lamented how it was at least five years two late, but there was one aspect of the story that I didn't really dwell on, although I did mention it. It's something I hadn't known about before, something I was actually pretty shocked to find out, and I wanted to know how it could possibly have happened. I'm referring to the fact that Mark Geier's son David Geier had somehow slimed his quacky 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. 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 quackery like the Geiers' Lupron protocol, which is in essence chemical castration, a treatment normally used for metastatic prostate cancer in men and endometriosis in women. The drug is also used in some protocols for in vitro fertilization in order to shut down sex hormone production, allowing the physician to control the hormonal cycle completely. In any case, as has been documented extensively, there is no biological rationale for using Lupron, and the rationale that the Geiers use, namely that testosterone binds to mercury and that lowering testosterone "frees up" mercury so that it can be chelated more easily, is utter nonsense. Yet somehow a man associated with such rank quackery was appointed to Maryland's autism commission. It's expensive, too. Lupron therapy can cost $5,000 to $6,000 per month, an expense insurance will cover in children only for precocious puberty, a diagnosis that the Geiers also play fast and loose with.
So how did David Geier get on the 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 despicable quackery. They're advocacy of abuse of autistic children. But controversial? Not so much. I do hate it so when clueless flaks like Paulson mislabel idiocy as being "controversial," the implication being that there is a real scientific controversy. In the name of this, David Geier was put on the panel in the name of "giving the other side a voice":
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.
I also hate it when quacks like the Geiers are excused by well-meaning legitimate experts:
Dr. Gary Goldstein, president of the Kennedy Krieger Institute, a premier institution for treating autism, said he'd been dismayed by reports of doctors prescribing Lupron for the disorder for years but did not know about the Maryland doctor.
He said there are drugs to treat symptoms and behavioral therapy, but no medication to treat the core disorder. About 1 percent of children have autism, which inhibits social skills.
"You have to take a step back and understand the frustration and desperation of parents with children with autism," he said. "We have no real medical treatments for the core symptoms of autism. Unfortunately, there are physicians out there, some well-meaning I suppose, who tell them herbs or medications will make a difference."
Which is true, but relatively irrelevant to the case of Geier père et fils. Think of it this way. The Geiers have build a virtual "autism biomed" empire in Maryland, Illinois, Indiana, Texas, Florida, New Jersey, Kentucky, and Washington based on, in essence, the chemical castration of children. Speaking the Geier's biomedical empire, we have to remember that he'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 accept 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.
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. The second, and more important, hope is that this cascades, and Mark Geier finds himself losing his medical license in each and every state in which he holds one.
Only then will autistic children be safe from one quack. Unfortunately, there are always others to take his place.
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I took the initiative of writing my state delegate here in Virginia, who happens to be a ranking minority member on the health and welfare committee. I made his office aware that Geier was licensed in Virginia and asked what legislation there was that could immediately strip him of his right to practice, and if there was no such legislation why not? It seems unconscionable that if emergency action is required against a practicing doctor for this kind of abuse that it does not automatically disqualify them from practicing in the state until their review instead of barring them from practice pending a review.
I don't know what will happen yet--my delegate is out of the country until Monday. But his office contacted me via phone within an hour of emailing my concern that Geier could practice in Virginia and that it would be a location of convenience for him. They are currently investigating what they can do (or what I need to do) to ensure his license is removed in Virginia as well.
I'll keep everyone posted as this goes on.
Actually Orac, I hope Geier fils pushes back a little longer to stay on the Commission...so that the Baltimore Sun reporter writes some more articles about the Geiers.
Obviously, he was recommended by someone who has the governor's ear; a legislator or citizen(s) who love the science behind the Lupron castration.
I looked into the Commission's website "Meetings" and they just had a meeting on April 26th...I'd love to see the minutes of that meeting.
Apparently it's something in the Geier gene pool where daddy lies about his credentials and Junior also lies about being a diagnostician.
In the main, this is a good thing.
A quack is put out of business with the stroke of a pen, and his son is now under the harsh light of the press.
Excellent.
Pathophilia has done the good service of providing a chart of Geier's licenses:
http://bmartinmd.com/2011/05/geier-medical-license-suspended.html
Based on the chart, it looks to me like action v. Geier(s) elsewhere could be largely redundant. In Indiana and New Jersey, Mark Geier's current licenses expire at the end of June. Licenses in Hawaii, Missouri, Kentucky, California and Virginia expire in Jan, Feb or May 2012, and the Florida license expires in Jan 2013. Thus, it looks to me like, in many if not most of these states, it could take less time for the authorities simply to let Mark Geier's license quietly expire than to take formal action against him.
David N. Brown
Mesa, Arizona
I'd like to hope that this is the start of a backlash against much of the autism nonsense that has built up over the last 15-20 years. With the utter demolition of Wakefield and the more subtle effect of internet savvy being increased amongst the public, I think that slowly more and more people are becoming aware of how badly they have been fooled by these quacks.
Unfortunately there is still a hardcore of 'true believers' but the support that these movements used to have with the general public seems to have ebbed away. Hopefully without this support politicians will have the ability to act against quacks like the Geiers, without having to worry about their poll ratings.
Just sent an email to the Indiana Medical Board with a copy of the Order of suspension from Maryland.
I, too, am very curious what went into the Maryland governor's decision process. As I noted over at Harpocrates Speaks, the decision is ultimately the governor's responsibility alone and cannot be delegated. Also interesting is whether or not David Geier will be investigated. If he did, indeed, practice without a license, that's a felony.
It wouldn't surprise me if there was a lot of pressure for an investigation. I've contacted the MD - OAG and asked a couple of their offices about the Giers. I received a "no comment on active investigations" so sounds like something is in the works.
One thing that seems to be coming out of this is that general public is becoming more aware of the charletons preying on autism parents. The curious part is that the general perspective seems to be that, yeah, these are snake oil salesmen and not legitimate. That's taken as a given. But listen to those parents, they constantly defend the quacks. Its as if they are the only ones who can't see it.
This is just like the Wakefield case where, as soon as his work was retracted, the media suddenly got far more critical of the whole anti-vax movement. I see the same thing happening here. These guys will become the poster children for quacks preying on autism, and perhaps even initiate the general public backlash against all such clowns. One can only hope.
I just wish the media would jump on this without some major event to trigger it
Just received an email from the Director of the Indiana Medical Licensing Board that they have filed a complaint with the IN Attorney General's office and an investigation is underway.
I have a third. It's that both Geiers are locked up for insurance fraud and child abuse. For a very long time.
@Beamup
Well, David Geier may face some jail time (and hefty fines) for practicing without a license, if the MD medical board decides to investigate him further, which seems like it might happen.
The state of Missouri has been notified, and the St. Louis Post Dispatch has investigative reporters on the story.
I'd like to publicly thank Kathleen Seidel for tirelessly pursuing these quacks; she has saved who knows how many children with autism from painful and potentially dangerous treatments. As a taxpayer, I can only hope state governments go after them too for medicaid fraud.
I can only hope state governments go after them too for medicaid fraud.
Is it known whether the Geiers or others on staff at their clinics "treated" Medicaid recipients? Based on the high costs of the tests and ensuing protocol, as well as the Willie Sutton principle (Medicaid's low reimbursements being where the money isn't), it doesn't seem the likeliest demographic for Geier customers.
I'm not sure that Dr. Gary Goldstein can be considered a legitimate expert in the field of autism if he's going to talk about autistics as objects that parents get desperate over, rather than people with medical outcomes and individual ideas of what constitutes a good outcome.
Off topic, sortof, but my 12 year old son was diagnosed, yesterday, with "probable PDD" which is a high-functioning autism. He was diagnosed with ADD in 2007. I also have a non-blood related nephew that has Aspergers Syndrome, he has an identical twin that is not on the spectrum (what might be called normal). He was never vaccinated, his mom is a complete woo subscriber. They're in Australia, I'm in America, and I've been forbidden by family to speak of it. However, had I ever heard that she was attempting to do something like chemical castration to "fix" her son, I don't think I could hold back anymore.
I don't believe the Geiers did this out of simple malace, I think there is actually something psychologically wrong with Mark Geier and possibly his son, most likely a genetic trait. It would be interesting for the criminal justice system to get him a psychological review, I don't think it would be kind to his ego.
@14
I know of parents who have been to the Geier's clinic who say medicaid paid the whole tab. Infuriating.
While I'm really glad to see this happen, it took an *awfully* long time. Geier Sr has an MD and a prescription pad making him subject to more scrutiny than his son would be. Weren't complaints made by *someone*- if not by a parent, by another medical professional- or a pharmacist- who knew what was going on? The father and son team were building an empire based on nonsense in *eight* states over *time*. It just boggles the mind.
If we step back and consider non-MDs like Geier Jr who are managing to make a handsome living off the public's lack of suspicion about "miracle" treatments for difficult conditions. David was able to weasle himself a state appointment which gave him important stature when he did his snake oil pitch. Slime- like woo -is unctuous and able to seep into any unsecured crevice. Even into universities and med schools. Whenever NDs or nutritionists follow their "calling" aren't they indeed, by the tenets inherent in their particular brand of woo, "practicing medicine without a license"? They diagnose and treat real, live people with spurious nostrums based on folklore and dodgy science.
It *bothers* me to no end that this is happening in the 21st century in the US and Western Europe- aren't we supposed to be the Post-Enlightenment Modernists? Living in reality? There were lot of intriguing activities occuring in the 18th Century - medicine wasn't one of them. I hope we're not on our way back there. I think that we live in the proverbial "interesting times" of the famous curse/ blessing.
What I wonder is: why the people who have previously lauded the Geiers are still silent?
@Denice Walter
Looks like the first complaint to the MD board about Geier Sr. as in 2006. Not a patient or parent of a patient, so someone that saw and was concerned enough to say something. There were 2 other complaints mentioned in the suspension order: one from a physician who referred (and subsequently removed the referral) a patient to Geier, and one from the mother of a patient.
As you all know the Autism One Conference has scheduled "150 Experts in the Autism Field" during their 5 day jamboree in Chicago at the end of this month.
I have the schedule, with the "usual suspects"; notable are two seminars:
Cutting Edge Therapies For Autism: The Role And Treatment Of Elevated Male Hormones And Associated Clinical/Behavioral Problems
David A. Geier, BA
Mark H. Geier, MD, PhD, FACMG, FACE, ABMG
The Matters of Munchausen Syndrome By Proxy vis-a-vis Autism Spectrum Disorders
Andrew Wakefield, MB, BS, FRCS, FRCPath
I posted in a prior RI blog that Andy's latest cause and "expertise" is now Munchausen By Proxy Syndrome related to ASDs. I suppose he will attempt to be a "qualifed expert" in criminal cases now for parents who batter/murder their children. Wasn't there a recent case of a male parent who somehow beat a criminal charge due to testimony of an expert in vaccine injuries?
@ Jud: As I posted/stated on Orac's Blog "Why not just castrate them (Part 6)...My money would be on the Medicaid Fraud Bureau to investigate, recover all the money and levy fines to the Geiers and in the case of the most egregious Medicaid fraud to pursue criminal charges (through the State's Attorney General).
Just FYI, I did some looking at the status of the Geier operation here in Washington. They have an office listed in Redmond, but, interestingly, I'm unable to find any valid Washington credentials listed for either Geier or for the RN in charge of the office, Lisa Reents.
There is also no separate Web site for the office, their local phone number is an 877-, and the office hours say "Closed" Monday through Sunday. I'm guessing that the office is a "placeholder" for a future expansion, which hopefully will never happen - either that or a fake office to give them more national credibility.
lilady writes:
...and in the case of the most egregious Medicaid fraud to pursue criminal charges (through the State's Attorney General).
Due to state budget constraints, it could be that the HHS OIG and the Justice Department would be more likely to pursue enforcement for violations of laws under this joint state-federal program. But really, who cares which?
Seems like I answered my own question posed above, "Wasn't there a recent case of a male parent who somehow beat a criminal charge due to testimony of an expert in vaccine injuries?"
The male parent was Alan Yurko whose girlfriend's 10 week old infant died due to injuries from Shaken Baby Syndrome. He was found guilty of murder and imprisoned for life until some anti-vax nuts took up his cause. He appealed the conviction and was successful...not because of "expert testimony" offered up by anti-vax specialists...but because of technicalities associated with the written autopsy report. Furthermore, when the State indicated they would re-try the case, Yurko copped a plea to manslaughter.
Orac blogged about this whole sordid mess:
The depths of anti-vaccination lunacy (March 7, 2007)
Just when Wakefield seeks to qualify himself as the hired gun witness for parents accused of Munchausen By Proxy injuries inflected on their child...the Geiers have been exposed for their castration treatments of children; tough luck, Andy.
@22 Addendum. Another search did find a current MD license for Mark Geier in Washington - the rest appears to be correct.
@25 I found Geier's MD for WA. Noticed something curious.
It was renewed 4/5/11 and expires 25 months later on 5/3/11. First issue was on 12/1/08, which means second renewal should have been around 1/1/10 and third around 2/1/12. He renewed 9 months early and only 3 weeks before his MD in MD was pulled. He must have seen the writing on the wall.
Time to email the local WA folks.
Dang. Bad math.
First renewal would have been 1/1/2011, not 2010. So he either let it lapse 3 months then renewed or he renewed 22 months early. Well, perfectly good conspiracy theory shot down by the facts, probably.
I've emailed the WA board about Geier.
Damn, you guys are good
The Geier mess has been featured on the websites of mainstream media...L.A. Times...Seattle Times...Chicago Tribune...Washington Post and Miami Herald.
Another development in this whole thing. The Maryland Board of Physicians wants to talk to parents of autistic kids who have had interactions with David Geier. Parents are urged to call the board at 410-764-4777 if they have seen him diagnose, perform procedures, prescribe, act as an expert and so on. Please spread the word about this. They can even be called over the weekend. Parents who call should ask to speak to an investigator about the Geier case.
@29 - I suspect they will not get much cooperation. I once heard an interview with an RCMP commercial crimes detective who was investigated and Ponzi scheme that defrauded numerous people in 2 small towns in Alberta. He was very frustrated at the lack of cooperation he got from the victims, many of whom insisted that the instigator was in the US trying to find where the money had gone. People who have been defrauded will often defend the fraudster rather than admit that they were conned. This effect is even stronger when it comes to medical fraudsters. Admitting they were conned by the Geiers would be mean admitting they exposed their children to risk and/or harm. That is going to be tough to do.
@10:
As I pointed out, Geier's Indiana license expires in June anyway, so any formal charges by the state medical board will almost certainly be too late to make a difference. But, being under investigation might be decisive if/when he tries to renew.
I e-mailed the WA state Medical Quality Assurance Commission on Thursday night and received the following response on Friday morning:
"The Medical Quality Assurance Commission was alerted to the Maryland
action on May 4, 2011. A case has been opened and the Commission is in
the process of obtaining all relevant documentation.
Thank you for bringing your concerns to the attention of the Medical
Quality Assurance Commission. I can be contacted at 360-236-2770 if you
need additional information.
James H. Smith, Chief Investigator
Medical Quality Assurance Commission"
Nice to know that they are on the ball.
I e-mailed the WA state Medical Quality Assurance Commission on Thursday night and received the following response on Friday morning:
"The Medical Quality Assurance Commission was alerted to the Maryland
action on May 4, 2011. A case has been opened and the Commission is in
the process of obtaining all relevant documentation.
Thank you for bringing your concerns to the attention of the Medical
Quality Assurance Commission. I can be contacted at 360-236-2770 if you
ı am learn
@ Militant Agnostic: Great comment about reluctance of parents to admit they were complicit in chemical castration.
Also I suspect that when parents tacitly "agreed" to the Geiers' diagnoses of "precocious puberty"...the only medical reason for private insurance and Medicaid to cover costs of Lupron...they actually participated in insurance fraud.
@Militant Agnostic
Oh, I agree that there may be reluctance on the part of the victims, for a variety of reasons. Still, good to get the word out there.
@31 Most IN medical licenses expire June 30. I know mine was up for renewal. Had he renewed 2 weeks ago like I did he would have skated through.
Dr. Geier is also licensed in Texas thanks to one Vale Krenik, whose writings about the CDC are hard to believe. Mr. Krenik who got his law license just four years ago and is already under investigation by the Texas State Bar after a number of complaints. He claims to have an "ivy league" education from "Reed College" of Portland Oregon, which anyone with a brain knows is absurd. He claims to have founded his own IT company in Portland by the name of "Xenium", which is actually a temp agency in Portland in business for 30 years! Mr. Krenik is just as much a fraud as Dr. Geier!
Wow!such a feeding frenzy. In case anyone cares, the use of Lupron or Androcur in children with a diagnosis of precocious puberty or hypertesticular function is to reduce androgens to a level normal for the child's age. The goal is NOT to reduce the androgen levels to zero, that is, to castrate them.
Piranha doesn't care because piranha just feeds.
It's a mindnumbing affair.
@Amos
You are correct, that is the aim of giving Lupron in precocious puberty, but it seems clear that in at least some cases the Geiers were deliberately giving children a false diagnosis of precocious puberty to justify giving them this drug.
Precocious puberty is by definition signs of puberty before the age of 9 in males (8 in females). Treatment continued after the time puberty would normally occur is effectively castrating the child.
The package insert for Lupron states:
"Discontinuation of LUPRON INJECTION should be considered before age 11 for females and age 12 for males"
The Geiers treat boys in their teens and even in their twenties with Lupron. Precocious puberty in a young man in his twenties?
Also from the Lupron package insert:
"The recommended starting dose is 50 mcg/kg/day administered as a single subcutaneous injection. If total downregulation is not achieved, the dose should be titrated upward by 10 mcg/kg/day. This dose will be considered the maintenance dose."
According to the Geiers, speaking at Autism One 2005, they gave their first two male patients, aged 8 and 6 years old, 22.5 mg straight off. The upper 95th percentile weight for an 8 year old boy is 35 kg (I'm being very generous here), so the dose the Geiers gave was at least 643 mcg/kg or more than 10 times the normal dose to treat precocious puberty. Repeated doses were given after this.
The Geiers use of 10 times the dose of Lupron normally used to treat precocious puberty in much older children and young adults is effectively chemically castration.
I think the "feeding frenzy" is quite justified.
Augustine - do you really approve of what the Geiers have been doing? Really?
@Amos
I forgot to mention Androcur and also hypertesticular function.
Much of what I have written about Lupron applies equally to Androcur, except Androcur has far worse side effects.
It may be my ignorance, but I have never heard of "hypertesticular function" as a medical condition. I did spend over 20 years working as a biomedical scientist in clinical endocrinology, and have looked at thousands of serum testosterone results, but I don't recall that diagnosis. It certainly isn't an indication mentioned in the Lupron package insert.
Thanks Krebiozen, you're correct. My memory is not so good. I meant to say "Testicular hyperfunction" ICD code 257.0
@Amos
I should have recognized the transposition. Testicular hyperfunction is a very rare condition, and I doubt very much that it is an unnoticed cause of autism, especially as it is normally caused by a tumor, as far as I remember. I suspect the Geiers have been using another bogus diagnosis to justify prescribing Lupron and Androcur to post-pubertal children and young adults.
Amos,
That used to be the code in the ICD 9 days; it's now N29.0 under ICD 10. Lot easier to remember, methinks. Otherwise, yes... you're right.
I'd like to hope that this is the start of a backlash against much of the autism nonsense that has built up over the last 15-20 years. With the utter demolition of Wakefield and the more subtle effect of internet savvy being increased amongst the public, I think that slowly more and more people are becoming aware of how badly they have been fooled by these quacks. thank gooddd dilber ay yeÅilçam
@David Andrews:
Unfortunately, here in the US we have not quite made the switch to ICD-10. We are still working on ICD-9 because the US government, in their infinite wisdom (?) is giving insurances and doctors, etc, until 2013 to make the switch so, as per usual, no one has started.