Tuesday, May 3, 2011

Mark "Castrate 'Em" Geier's License Suspended

On April 27, 2011, the Maryland State Board of Physicians, the body that grants physicians the privilege to practice medicine, issued an Order for Summary Suspension of Dr. Mark Geier's License to Practice Medicine (PDF). This has been a long time coming, and, I have to say, I am greatly relieved that it has finally happened.

Most people reading this blog probably already know who Dr. Geier is. For those who don't, here's a little background.

The Geiers

Dr. Mark Geier is part of a father-son team of (I hate to use this term for them) "researchers" who purport to treat autism. Dr. Geier and his son, David, have a notion that the mercury in thimerosal, a vaccine preservative, causes autism. Following this belief, they have subjected children with autism to chelation, a treatment with potent drugs that leach certain chemicals (like mercury, lead, calcium, etc.) out of the body. They also believe that mercury and testosterone bind together in sheets, preventing the elimination of mercury from the body and, thus, causing autism. This has led them to use Lupron, a drug used to treat precocious puberty and to chemically castrate sex offenders, in combination with chelation to treat autism. In order to conduct their studies, they even went so far as to set up their own Institutional Review Board, which was in violation of Federal regulations governing IRBs, to give a patina of respect, while working around all those pesky rules that are meant to protect the kids on whom they experimented.

Chelation

Chelation has valid medical uses, such as for the treatment of heavy metal poisoning. The treatment is approved for use only after a blood test has confirmed heavy metal poisoning (though, as I've written about before, there are labs who are more than happy to use fraudulent tests to "confirm" elevated levels of heavy metals). It is not approved for the treatment of autism and is, in fact, a rather risky treatment in and of itself. Two similar drugs are used for chelation: Edetate Disodium (EDTA) and Edetate Calcium Disodium (Calcium EDTA). Searching the FDA web site, EDTA has been discontinued, but I was able to find the label for Calcium EDTA (PDF) which carries a black box warning, indicating that "[t]he mortality rate in pediatric patients has been high". Its use can lead to a range of dangerous side effects, such as low calcium, low blood pressure, heart, liver and kidney problems, seizures and so on.

Calcium EDTA is approved in the U.S. for the indications mentioned above. The Geiers, however, use DMPS, which is not approved by the FDA. It is thus experimental and must therefore be used only in the context of a clinical trial or through the FDA's expanded access program.

Lupron

Lupron (leuprolide acetate) is a drug that is approved for the treatment of precocious puberty in children, as well as endometriosis in adult women and, as Orac notes in his post over at Respectful Insolence, metastatic prostate cancer in men, in place of the old treatment: surgical castration. It works by inhibiting the secretion of gonadotropins, hormones that regulate growth and sexual development. This drug is in a class of drugs called antiandrogens, which block male sex hormones, like testosterone. It is also used for the chemical castration of sex offenders. It carries a number of risks, including seizures, bone damage and heart damage. Like the chelating agents mentioned above, Lupron is not approved for the treatment of autism. Treatment with Lupron costs about $5,000 to $6,000 per month.

The Complaints

August 15, 2006 - Case 2007-0083
The first complaint appears to have been made in 2006, by an individual who was neither a patient not a parent of a patient of Dr. Geier. The complain alleged that Dr. Geier:
  • Practices outside the scope of his expertise and the prevailing standard of care for autism;
  • Experimented on children without a rational scientific theory or the supervision of a qualified review board; and
  • Failed to provide appropriate informed consent regarding the potential side effects of Lupron and similar drugs.

January 15, 2008 - Case 2008-0454
A physician who referred a patient to Dr. Geier alleged that Dr. Geier:
  • Performed an inappropriate evaluation;
  • Made an incorrect diagnosis; and
  • Treated the patient inappropriately.

The physician asserted that Dr. Geier is not board certified in either pediatric medicine or pediatric endocrinology. The patient was diagnosed as having an endocrinological problem despite having normal lab results. The patient was prescribed Lupron for a "non-existent problem".

October 8, 2008 - Case 2009-0308
The parent of a patient alleged that David Geier (Dr. Geier's unlicensed son) performed an ultrasound on her son, as well as ordering extensive and numerous lab studies. Mr. Geier also diagnosed "insomnia" and "metabolic disorder". (I'm not certain, but I think that is what is called practicing medicine without a license.)

Eleven patient records, including those of cases 2008-0454 and 2009-0308, were submitted by the board for peer review on October 26, 2010. Two of the cases were declined, citing reviewers' lack of expertise. The results for the remaining nine were received January 25, 2011.

The Findings

The board found that Dr. Geier lacks the qualifications and expertise necessary to assess and treat autistic children, and that his operations are outside the standard quality of care for autism.

The Respondent [Dr. Geier] 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 underlying medical condition.

The board also found that he did not provide adequate informed consent to the parents and "in one 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.

Patient-Specific Findings

Over the course of 28 pages, the board provides painful details about the 9 patients whose records were reviewed. Misdiagnoses, failure to collect proper histories, failure to conduct appropriate diagnostic tests, inappropriate prescription of drugs, inadequate informed consent for the parents (despite criticizing other physicians for supposed lack of informed consent), undated or missing records; the list goes on. Since the findings section is rather long and full of information, I won't summarize it here. Instead, I urge you to read the findings for yourself.

Inappropriate IRB

Earlier, I noted how Dr. Geier drummed up his own IRB to appear to comply with regulations governing human subjects research. The Maryland board also documented the failures and irregularities involved in Geier's IRB. The IRB of record for his research is at the Institute of Chronic Illness (ICI). ICI's address is Dr. Geier's home address. The members of the IRB include Dr. Geier, his wife and his son, David. Regulations dictate that no member of the IRB can be involved or have a conflicting interest in the research governed by the IRB. (Edited to add: Though not noted in the order, I also recall that the IRB was set up after the research program was started, a definite no-no.) In short, Geier was overseeing ethical review for his own research, in clear and flagrant violation of the law.

False Credentials

When the Maryland board interviewed Dr. Geier in November, 2007, he asserted that he was board certified as a geneticist and as an epidemiologist. However, it turns out that Dr. Geier lied. He is not certified as an epidemiologist, nor does he hold certification as a geneticist. Instead, he is certified as a genetic counselor. These are two very different certifications.

Board Conclusions

The board ordered the summary suspension of Dr. Geier's medical license on April 27, 2011. A post-deprivation hearing is scheduled for May 22, 2011 at 10:00am at the Maryland State Board of Physicians. After the hearing, Dr. Geier has 10 days to request an evidentiary hearing, if he is unsatisfied with the results of the May 22 hearing. Upon presentation of the board's order, Dr. Geier must surrender:
  • his original Maryland license D24250;
  • his current renewal certificate;
  • his Maryland Controlled Dangerous Substance Registration;
  • all controlled dangerous substances in his possession and/or practice;
  • all Medical Assistance prescription forms;
  • all prescription forms and pads in his possession and/or practice; and
  • any and all prescription pads on which his name and DEA number are imprinted.

In short, Dr. Geier is pretty much done in Maryland. But that will not stop him, I'm afraid. As noted in the order, he intends to open clinics throughout the United States, saying that he "plan[s] to open everywhere. I am going to treat as many as I can." It should also be noted that Dr. Geier holds active medical licenses in 10 other states: California, Florida, Hawaii, Illinois, Indiana, Kentucky, Missouri, New Jersey, Virginia and Washington.

I do not know whether the Maryland State Board of Physicians' action has been communicated to these other state medical boards, but, as with any physician who has been subject to disciplinary action such as this, they should be notified. They may then review the notice for themselves and contact the Maryland board to discuss any further questions they may have.

There is also the matter of Dr. Geier's son, David. After reading the Maryland Board's order, I get the distinct impression that he was practicing medicine, despite lacking a license to do so.

In the end, the Maryland Board's action is a welcome and much overdue event. It does not stop Geier from the inflicting harm on other children in other states. By itself, it will not prevent him from swindling parents or insurance companies, but it is a step in the right direction. I can only hope that the other states follow suit.

Disclaimer: This post represents my understanding of the facts of the case and my interpretation and opinions thereof. They do not constitute declarations of fact in and of themselves and should not be interpreted to be libelous. If any errors of fact are discovered, I am more than willing to review my words and change them as appropriate.

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Others who have written about this:

Liz Ditz at I Speak of Dreams
Seth Mnookin at The Panic Virus
Steven Novella, MD at NeuroLogica
Orac at Respectful Insolence
Phil Plait at Bas Astronomy
Prometheus at Photon in the Darkness
Kathleen Seidel at Neurodiversity
Sullivan at Left Brain/Right Breain
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3 comments:

  1. Excellent post.


    Let's hope the other states follow suit and that a DA in one of these states pursues charges against him.

    ReplyDelete
  2. Isn't it odd that there has been exactly zero reaction (that I can find) from the "autism is vaccine injury" crowd?

    ReplyDelete
  3. Yeah. Perhaps silent from shame?

    ReplyDelete

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