No, antivaccine quack Mark Geier has not been exonerated, but the Maryland Board of Physicians appears to have screwed up

There was a time when I used to write a lot about Mark and David Geier, the father-son team of autism quacks who “pioneered” chemical castration with Lupron as a treatment for autism. Mark Geier is the father and an MD, while David Geier is the son and has no relevant medical training. That time was nearly twelve years ago, when I (and other bloggers) first noticed this particularly horrific bit of quackery being perpetrated on autistic children. We also noted how the Geiers played fast and loose with the rules governing human subjects research, using their own dubious institutional review board (IRB) to oversee their “clinical trials” testing what they called the “Lupron protocol.” They even had a self-constructed laboratory in the basement of Mark Geier’s house, complete with incubators and a cell culture hood, where they pretended to do real research.

Sadly, it wasn’t until three years later that the mainstream press started to notice the Geiers’ quackery that skeptical bloggers had been writing about for years. As a result, in 2011 the Maryland Board of Physicians took emergency action to stripped Mark Geier of his medical license and bring action against David Geier for practicing medicine without a license, fining him $10,000. At the time, the Geiers had been franchising their Lupron protocol, leading to its spreading to Florida (with the help of wealthy Florida chiropractor and Republican donor Gary Kompothecras, the same man who arranged for antivaccine icon Andrew Wakefield to meet with Donald Trump when he was campaigning in Florida).

Mark Geier

Mark Geier, pretending to be a real scientist again.

Before today, I hadn’t written about Mark Geier in years, the last time being in 2013, when, for some reason, the George Washington School of Public Health allowed him to mentor a graduate student in epidemiology. Over the weekend, though, I was forced to take notice of the Geiers again when people started sending me a link to a story in the Washington Post, Regulators who targeted anti-vaccine doctor may pay millions for humiliating him, and, not surprisingly, yesterday the antivaccine crank blog Age of Autism was proclaiming that this somehow proves that there is a vast conspiracy against the Geiers. Let’s take a look at the crank version of events and compare to the real version of events.

First, some revisionist history:

Note: A decade or more ago, chelation and other forms of mercury/heavy metal removal were very much at the forefront of autism treatments. The pediatric vaccine schedule had been bloated with bolus doses of mercury and many parents saw success in remediating autism symptoms via chelation. Dr. Geier spearheaded a treatment with Lupron, to target testosterone with the goal of ameliorating AGGRESSION. In 2018, Anne Dachel is writing about the skyrocketing rates of aggression in school aged children, with and without special needs or autism. School shootings are a regular occurrence. Had Dr. Geier been able to conduct his work, perhaps we might have had a mechanism to lower aggression. Alas, the powers that be (talk about your deep state, and I don’t even know what that phrase actually means) have NEVER allowed a single autism “TREATMENT” outside of ABA and other non-medical interventions.

This speculation is utterly astounding in its level of brain death. Lupron is the trade name for a drug called leuprolide acetate a synthetic analog of a hormone known as gonadotropin releasing hormone (GnRH, a.k.a. LH-RH). After causing an initial stimulation of gonadotropin receptors by binding to them, chronic administration of Lupron inhibits gonadotropin secretion, specifically leutenizing hormone (LH) and follicle stimulating hormone (FSH). The end result is the inhibition of the synthesis of steroid hormones in the testes in men and in the ovaries in women. In men, testosterone and androgen levels fall to castrate levels, and in women estrogens are reduced to postmenopausal levels. It’s main use in men is to treat metastatic prostate cancer without surgical castration. (It is, after all, chemical castration.) In women, it is sometimes used to suppress the ovaries in the treatment of estrogen-responsive breast cancer. It’s also used in some in vitro fertilization protocols. In children, there is only one medically accepted use of Lupron, and that is to treat precocious puberty, defined as the onset of secondary sexual characteristics before 8 years old in girls and 9 years old in boys. As I described in great detail the first time I wrote about this protocol, there is no good evidence that lowering testosterone levels is a valid treatment for autism. Subjecting autistic children to Lupron to treat autism is, without a doubt, the rankest quackery, and that is why the Maryland Board of Physicians acted. Never forget that.

So what happened? This:

But the regulators who stripped Geier’s credentials are now in the hot seat, ordered to each personally pay tens of thousands of dollars in damages by a judge who says the board abused its power in an attempt to humiliate the doctor and his family.

The board posted a cease-and-desist order on its website in 2012 alleging that Geier had improperly prescribed medication for himself, his wife and his son while his license was suspended. In an unusual move, the order named the drugs in question. Online critics of Geier took notice, mocking the doctor and his family in blogs and comments for their use of the medications.

The Geiers say the state publicized those details for vengeance, to punish a doctor with unconventional ideas. State officials say it was an honest mistake.

But Montgomery County Circuit Court Judge Ronald B. Rubin sided with the Geiers, awarding them $2.5 million in damages.

If anyone should know better than to do something like this, physicians who make up the Maryland Board of Physicians should know that this is simply not done. Why were the Geiers so embarrassed by the revelation of the drugs being used? I happen to know which drug was prescribed, and I’m not sure why it would be so embarrassing, but I’m not going to identify it anyway. It doesn’t really matter. Including it in a publicly available cease-and-desist order is simply not done. It didn’t need to be done, and the judge slapped the board down hard for it:

He called the order a significant breach of medical privacy and accused the board and its staff of failing to preserve emails related to the case and pleading ignorance about the order on the witness stand.

“If their testimony were to be believed, which the court does not, it is the worst case of collective amnesia in the history of Maryland government and on par with the collective memory failure on display at the Watergate hearings,” Rubin wrote in a December opinion.

He ordered 14 board appointees, the board’s lead attorney and the lead investigator on the Geier case to pay half of the damages out of their own pockets, between $10,000 and $200,000 apiece, depending on their net worth.

In fairness, I note that some of the board members dispute this version of events. Certainly this judgment is heading for appeal, and the judgment could well be reduced or even thrown out. I’m not a lawyer; I don’t know what the likelihood of either outcome is. I am, however, disturbed enough to note that some of the behavior of the board certainly sounds unprofessional and foolish. For instance:

Rubin described the decision to name the drugs in the order as an extraordinary breach of privacy for an agency that should know better than anyone else the importance of confidentiality in the medical profession. He pointed to emails sent later on during the probe as evidence of the board’s motivation to embarrass the Geiers.

Pepper referred derisively to the Geiers as “Daddy G” and “Baby G” in emails to Josh Shafer, the board investigator leading the probe of the Geiers.

“Maybe we can help make it a bad month” for the Geiers, Shafer wrote back, using a derogatory reference to the drugs they were using.

Pepper’s excuse sounds like 100% grade A bullshit:

At trial, Pepper said she knew the Geiers’ private medical information would be online as a result of the order, but didn’t think it would be embarrassing. She said she named the drugs to clarify that they weren’t dangerous controlled substances and named the recipients to clarify that Geier wasn’t prescribing the medication or juveniles.

The mind boggles that anyone would think that such an unbelievable response would fly. Moreover, the board was clearly asleep at the wheel:

All but one member of the Board of Physicians who voted to approve the cease-and-desist order on Jan. 25, 2012 later told the judge they didn’t actually read it.

“It is sort of like looking out an airplane window watching the pilot walking around kicking the rubber and pulling on the metal. I don’t have to go behind him and pull it. I trust the pilot to do his job,” testified Paul Elder, an anesthesiologist from Anne Arundel County who was appointed by former governor Robert L. Ehrlich (R) in 2003 and chaired the board at the time of the Geier investigation. “I trust the Board staff to do their job and construct a document that was ready for signature.”

The stupid, it burns. When you’re part of an official government board charged with enforcing state law and regulations governing medical practice, it’s grossly irresponsible of you not to read every order you’re asked to vote on to send out in the name of your board. I, too, trust staff to construct documents ready for signature. That doesn’t mean that I don’t read them before I do sign them.

I can’t help but note here that, if the judgment holds, the board will have handed Geier’s defenders a huge gift in terms of propaganda. Indeed, already the antivaxers over at Age of Autism are using this judgment as “proof” that Geier was persecuted, not prosecuted, by the Maryland Board of Physicians:

As an aside, Lupron was not a poison being offered by doctors. Back in the early 2000s my daughter Mia went to a pediatric endocrinologist in Cleveland at the prestigious Rainbow Babies and Children’s’ Hospital – the home of Dr. Max Wiznitzer. This young doctor, a Dartmouth Fellow, immediately suggested LUPRON for my daughter. Not for her autism, but for early development. The press always portrayed Dr. Geier as a Mengele experimenting on our children. When I asked the Cleveland Doc what Lupron would do to Mia’s seizures – increase them? Make them worse? He had NO IDEA. And yet he still was willing to put her onto Lupron.

I hope that other doctors who have been pilloried by their “peers” for trying to help families drowning in the challenges of autism take a bit of hope in this news below. Try to read around the snarky nastiness that is WaPo when it comes to our kids. They are wretchedly unsympathetic to our plight. Kim

As an aside, I note that clearly Dr. Wiznitzer thought that the Kim Stagliano’s daughter had premature puberty and that he was only expressing his lack of knowledge whether Lupron increases seizure activity. It’s not clear whether Lupron predisposes to seizures. If you read the Lupron website, you’ll note that it warns that seizures “have been observed in patients taking GnRH agonists, like LUPRON DEPOT-PED, with or without a history of seizures, epilepsy, brain or brain vessel problems or tumors, and in patients taking medications that have been connected to seizures.” In other words, they don’t know if the observed seizures were caused by Lupron or if Lupron predisposes to seizures. Of course, to me this is a good additional reason why it is a horrible idea to give Lupron to children who do not have a valid medical indication to need Lupron.

None of this stops the various commenters at AoA from gloating over the victory, rambling about “punishing” pharma, and even invoking Trumpian “deep state” conspiracies as the reason why the idea that vaccines cause autism is not accepted by the medical profession.

Time for a reality check. Mark and David Geier came up with their Lupron protocol based on not just one but two scientifically discredited hypothesis. The first is the idea that mercury in the thimerosal preservative that used to be in many childhood vaccines vaccines causes autism, a failed hypothesis. Second is the scientifically unsupported idea that somehow testosterone binds the mercury from vaccines that to them cause autism and makes it somehow more difficult to chelate. I kid you not. They called them “testosterone sheets.” Never mind that there is no convincing scientific evidence that chelation therapy does anything to help the behavioral symptoms of autism or that mercury in vaccines causes autism, and never mind that there is no physiological evidence that testosterone in any way binds mercury in the body, much less makes it inaccessible to chelation therapy. Never mind that the Geiers based their concept of “testosterone sheets” on a paper from 1968 looking at the crystal structure of testosterone and mercuric chloride derived from crystals made by boiling equimolar amounts of testosterone and mercuric chloride in hot benzene, conditions far from physiologic. They just speculated that testosterone binds mercury and that lowering testosterone would free up the mercury for chelation, even though there was no evidence for this concept. Yet, based on this concept, not only did the Geiers subject autistic children to both chelation therapy (which can kill) but to Lupron, which provides no benefit at not inconsiderable risk. They then franchised the idea and even tried to patent it.

Let’s also not forget that the behavior of the Maryland Board of Physicians, if indeed they did what the judge ruled that they did, has nothing to do with whether Mark Geier deserved to have his medical license revoked, the rantings of Erin Elizabeth and the antivaxers at AoA notwithstanding. He did, without a doubt. for charging huge sums of money for their dangerous quackery The revocation of his license went through all the due process, including appeal. Not only that, Maryland wasn’t the only state that took his license away. A total of twelve states did, and now Mark Geier does not have a license to practice anywhere in the US. This is a very good thing for autistic children, as the Geiers should be allowed nowhere near children with any medication. Nothing what the Maryland Board of Physicians might or might not have done to humiliate him publicly changes that. If the Maryland Board of Physicians did indeed do what the judge’s ruling says it did, it deserves some form of sanctions. After all, if it vindictively revealed something about Mark Geier’s medical history, it could do it to another physician. None of this means that Mark Geier has in any way been exonerated. He has not.