The father son team of Mark and David Geier have been causing mischief (to put it lightly) in the autism community for years. Mark Geier is a medical doctor but his son, David, never attended medical school and has no license to practice medicine or any form of health care. The State Board of Maryland recently concluded their hearing on David Geier finding him guilty of practicing medicine without a licence and fining him the whopping fee of $10,000.

It is good to see state boards of health doing their job and going after people who are, in my opinion, dangerous charlatans. They do far too little of this. But the fine amount is very disappointing. According to the order it is meant to reflect the amount that David Geier profited from his illegal activity. I don’t know what constraints the board has on them in this regard, but $10,000 is a slap on the wrist.

The Geiers are notorious among those of us who keep an eye on the anti-vax community because of their support for the mercury-autism hypothesis (to put it generously). In fact the Geiers developed a highly dubious theory and treatment, connecting autism to mercury and precocious puberty in boys – premature high testosterone. They put together their own institutional review that has been highly criticized for not meeting state and federal regulations. Through this board they got approval for a study in which they administered lupron, a drug that opposes testosterone and essentially causes chemical castration, to young boys who they diagnosed with autism. Their theory is that the lupron would allow chelation therapy to be more effective in treating mercury toxicity.

Every aspect of their claim is out of sync with mainstream medical evidence. There is no evidence to support the notion that mercury causes autism, that chelation therapy treats autism, that autistic boys have high testosterone, or that treating them with lupron will help in any way. The Geiers are out there by themselves on the fringe. Of course, they and their defenders portray them as mavericks being unfairly targeted by the system. In my opinion the system has failed to protect the public from them for far too long – although action is starting to come.

The fine against David Geier is a step in the right direction. Stephen Barrett has a good summary of the actions taken against the father, Mark:

In 2004, Geier was ordered to stop a research project because of alleged improprieties in data collection. In 2011, the Maryland State Board of Physicians summarily suspended Geier’s medical license. The emergency suspension order stated that he misrepresented his credentials, operated an institutional review board that did not meet state and federal regulations, and rendered substandard care to nine autistic patients. In six of the patients, the board charged, he inappropriately diagnosed precocious puberty (a rare condition) and administered Lupron, a drug that reduces the body’s production of the male hormone testosterone and is used to castrate sex offenders. In three of the patients, he administered inappropriate chelation therapy. The emergency order was subsequently upheld and the nine other states in which he was licensed suspended his license pending resolution of the Maryland charges. In 2012, Maryland charged him with violating its emergency suspension order.

At least there is some action attempting to stop the dubious medical treatments of the Geiers. I’m not really sure, however, why states have such a hard time taking appropriate action against obvious violations. Some states have health care freedom laws which protect practitioners of “alternative medicine” from the standard of care, but even that only goes so far. There seems to be a lack of will on the part of many states to pursue questionable practitioners, even when they are clearly violating the standard of care.

Further, the notion of practicing medicine without a license has lost much of it’s strength. They got David Geier red-handed, but what about all the fringe practitioners (supplement sellers, homeopaths, gurus, etc) who are essentially treating medical diseases without a proper license? Why is it so hard to go after them? Apathy may be an adequate explanation but seems too easy.