Even Worse: The Geiers' Lupron Protocol
By David N. Brown
This is a PUBLIC DOMAIN document (dated 8/24/09, revised and reformatted 8/25/09). It may be copied, forwarded, cited, circulated or posted elsewhere. The author requests only that it not be altered from its current form.
Chelation therapy would seem to be the definitive example of a useless, dangerous and unscrupulous treatment for autism. Yet, some things can be said in its defense. Even if heavy metal poisoning does not cause autism, it is obviously a real and serious problem, to which autistics might be more vulnerable to the general population. (Chelation advocates appear to be shifting toward mercury sensitivity as a comorbid rather than causal feature of autism. By my own evaluation, this more moderate argument is supported by no evidence, but plausible.) And even if autistics are at no more risk of heavy metal poisoning than the general population, it is hard to argue with the removal of accumulated metal from the body as beneficial to general health. But chelation therapy helped spawn another therapy which is even more inappropriate, and in some ways may be considered even more devastating to quality of life: the Lupron protocol, devised by the infamous father-son team of Mark and David Geier.
The Geiers' history is worthy of some comment. Elder Mark Geier started out as a reputable if undistinguished geneticist, who published some significant research on immunology (most notably on the role of the spleen in producing antibodies) in the 1970s. He moved into private practice in his own fertility clinic, where he made the questionable claim that he could decide the gender of children he helped in conceiving. (It is of some interest that, in the same field and at around the same time, Dr. Cecil Jacobson committed his well-documented and notorious fraud.) By the late 1980s, accompanied by David, he was testifying for litigants on vaccine-injury cases. By ca. 2002, they had joined the bandwagon of those blaming autism on vaccines and arguing for chelation as its cure. They soon became prominent in many areas. Among their scientific peers, the published several articles arguing that autism was caused by thimerosal, and sued four authors of one of many articles condemning their work. In court, they continued to testify in vaccine injury litigation, now over autism in particular, at least until a judge refused to accept them as “expert witnesses”. In the press, they received a visit from reporters for the New York Times, who described their lab equipment as “cast-off (and) unplugged”. In summary, the Geiers had secured a reputation as prominent if controversial figures in autism research and treatment, even before they suggested that autistic children be treated with Lupron, a drug best known for its use in the “chemical castration” of adult sex offenders.
The story of Lupron has been told often and thoroughly enough (see esp. articles by Kathleen Seidel at neurodiversity.org) to need little introduction. In 2005-2006, the Geiers proposed that autism could be treated by Lupron (“generic” name luprolide), a testosterone inhibitor approved for treating certain cancers and for premature puberty. (To the best of my knowledge, its use on sex offenders has occurred independent of physicians' recommendation.) They were not deterred by serious side effects, which in children may include stunted growth, delayed puberty (even beyond the “normal” time frame) and sterility. Two rationales were offered for this drastic and intervention. One was that testosterone bonded with mercury, preventing the mercury from being excreted during chelation. It is noteworthy that this amounted to a rationalization for the failure of chelation as a cure, and also that testosterone-mercury bonding is believed to be possible only under conditions alien and harmful to the human body. The other was that autistics had a very high rate of precocious puberty. It is the second claim (which may actually have come first) which I think worthy of most attention here.
It can be said, at the start, that any positive association of autism with excessive testosterone would have to be considered surprising at best and improbable at worst. As a a matter of “common sense”, a surplus of a growth hormone would be expected (rightly or wrongly!) to accelerate physical development, and lead to greater size and strength compared to same-age peers. No such pattern is evident in autistic children. If anything, they tend to have the opposite problem: Autistic children are routinely reported as small compared to same-age or even younger children, and also having poor muscle tone. Thus, by outward appearances, autistics have no more need for hormone suppressants than anorexics do for diet pills! This does not mean that a diagnosis of elevated testosterone is out of the question. It does mean that the Geiers' claim was counterintuitive at the start, and that a large body of evidence should have been necessary to get it taken seriously.
It appears that the Geiers convinced people of a link in part by performing tests of testosterone levels, and using the results . Witness this account (received and posted by Seidel): “My son's testosterone was high when tested (by the Geiers, or someone they recommended?), but when we did a bone age test it showed that he was underdeveloped for his age by at least a year or two.” In this and similar cases, there can be little doubt that the “results” were simply spurious, and it is hard not to suspect that the Geiers (or someone associated with them) willfully fabricated them. Comments like this one from Mark Geier (2005, after Seidel) only heighten such suspicions: “And just a last comment so that nobody misunderstands. We believe this therapy will work for most children who are mercury-toxic, whether or not — girls or boys — whether or not they are really in precocious puberty or not (sic). We chose to work with precocious puberty because that puts us in mainline medicine. You can’t criticize using Lupron for precocious puberty; we believe it’ll work for most people. We believe that measuring testosterone is interesting, but since the test doesn’t work, it really doesn’t give you a level (!!!)" By all indications, this means that the Geiers don't believe their own testosterone tests are accurate, and view the very diagnosis of precocious puberty as only an official rationalization for prescribing Lupron. Yet, one can give the Geiers and any associates a back-handed benefit of doubt. It is easy enough to get a false positive or grossly inflated reading without tampering, particularly where underqualified staff and inferior equipment and facilities are involved. Furthermore, the Geiers may sincerely believe in the “results” of their tests, at least where said test supports the forgone conclusion of the need for Lupron.
In any event, dubious test results are explicitly not the Geiers' sole or even primary basis for diagnosing premature puberty. It appears that what they consider the main indicators are behavioral, with the most significant being “masturbation behavior” and “aggressive behavior”. It is possible that, even if the Geiers recognize that these are not valid indicators of “premature puberty”, they sincerely believe that they are serious problems worthy of biomedical intervention. Of course, there concerns, however sincere, are a preposterous overreaction. To answer the first concern as briefly and delicately as possible, such “behavior” has long been recognized as common even in babies, and would only be of medical interest it there was a physiological response. As for “aggression”, autistics should be considered generally passive and non-violent, unless stressed or intentionally provoked. (See “Vicious When Poked With a Stick”.) The only reason why either would occur to a greater degree in autistic children is that autistics have characteristically poor awareness of social “norms”, which is most appropriately addressed through behavioral intervention. Furthermore, it is not improbable that perceived problems are exaggerated or unwittingly manufactured by observers who consciously or unconsciously pay more attention to children known to be “different”. In the final analysis, the Geiers' “behavior” claims, not to mention their clients' acceptance of their arguments, are less indicative of conscious fraud than of the broader and more insidious problem of culturally-based myths and prejudices: selective sensitivity to members of minority populations, lingering sexual taboos, and the discomfort of the last few generations with violence and other forms of “aggression” that were previously accepted and even celebrated as typical “masculine” behavior. In these terms, autistics, like any “scapegoat”, have simply had the burden of society's conflicted values foisted upon them.
The only bright spot in the history of the “Lupron protocol” is that it has received limited enthusiasm even in the circles of “vaccine blamers” and other interested parties. Andrew Hall Cutler, an advocate of chelation, has said, “The theory that testosterone ties up mercury (in the body) and keeps it there is insane.” Simon Baron-Cohen, whose argument for autism as the manifestation of “extreme male” traits may have contributed to the Geiers' theory, has warned against its use. In May 2009, Age of Autism posted an openly critical article by Dr. Leane Amet, and editor Dan Olmstead recounted refusing to give his daughter Lupron (after it was suggested for reasons unrelated to autism or mercury) because of concerns about its side effects. Even Abbot Laboratories, manufacturer of Lupron apparently decided some time ago that it wants nothing to do with the Geiers' therapy. Despite all this, it appears that the Geiers have had little trouble reaching a steady (if probably relatively small) stream of parents willing to have their children “treated” with Lupron. As of 2006, the Geiers claimed to have administered Lupron to fifty people. By now, even allowing for exaggerated figures from the Geiers and a subsequent decline of interest, it seems likely that more than a hundred children ave received Lupron as an autism treatment. All future use of this powerful drug in this manner must be stopped. The most direct step that can be taken is to define and prosecute the administration of luprolide to minors without an accurate diagnosis of precocious puberty as felony child abuse. This has already been done. In 2007, Sylvia Joanna Vazquez was convicted and given a ten-year sentence (though only one year in prison) on charges which included the indisputably unnecessary administration of Lupron to an adopted daughter.
The most direct and drastic actions should be directed against the Geiers, not only to prevent them from administering Lupron but to prevent them from practicing medicine in any capacity again. They have shown themselves to be not only underqualified and unethical, but dangerously irresponsible. If so far they have managed to avoid killing or crippling a patient, they will probably do so sooner or later. Fortunately, their actions on Lupron in particular should make it singularly easy to dispose of them. They have prescribed a powerful medication with significant side effects and no possible value for the disorder it is intended to treat. They have used the diagnosis of an unrelated condition, by criteria they admit to be unreliable or invalid, simply to justify this misuse of medication. They have also all but admitted to giving false information to pharmacies, insurance companies, and even the guardians of minor patients. There are three promising lines of attack. The first, and the minimum that should be demanded, is for regulatory and disciplinary agencies to strip them of what credentials they have. The next is for the government to fine them and their former patients to sue them into insolvency. The final measure, and possibly the only one which will end the threat they pose to the public, is to sentence them to prison, if possible (and feasible if child abuse charges were pressed successfully) for more years than there are likely to be in their entire lives.
So, why is anyone waiting?
David N. Brown is a semipro author, diagnosed with Asperger's Syndrome as an adult. Previous works include the novels The Worlds of Naughtenny Moore, Walking Dead and Aliens Vs Exotroopers, and the nonfiction ebook The Urban Legend of Vaccine-Caused Autism. This and other articles related to autism are available free of charge at evilpossum.weebly.com.