Confessions of a Quackbuster

This blog deals with healthcare consumer protection, and is therefore about quackery, healthfraud, chiropractic, and other forms of so-Called "Alternative" Medicine (sCAM).

Friday, March 25, 2005

Mark Geier Untrustworthy: Autism, Thimerosal, Vaccinations

Among the few medical doctors and scientists, and the many other misguided individuals who are fanatically opposed to vaccination, and who attempt to prove (without proper evidence) that vaccinations (and the preservative Thimerosal) are the major cause of autism and related neurological disorders, one often finds the names of Dr Mark Geier and Mr David Geier, his son, from the Genetic Centres of America.

I have emphasized the name Geier in bold, as well as highlighted the relevant passages in red, to ease the perusing of this blog entry.

In the "vaccinations-cause-autism" community, they are considered to be trustworthy sources of information. Well, they aren't trustworthy, and here's some information related to that matter.

Autism Diva also writes about them.

The following Weiss case contains a number of unfavorable statements regarding Mark Geier and his lack of qualifications:


In the United States Court of Federal Claims

OFFICE OF SPECIAL MASTERS

October 9, 2003


JEANINE WEISS and JOSEPH WEISS, Parents of CHRISTOPHER WEISS, Petitioners,

v.

SECRETARY OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, Respondent


No. 03-190V

ORDER

After receiving petitioners' expert Dr. Mark Robin Geier's two affidavits, the undersigned issues this preliminary ruling. The evidence in the medical records contemporaneous with the events at issue in this case show that Christopher Weiss did not have an acute encephalopathy on January 25, 2000, which was the 15th day after he received MMR vaccine on January 10, 2000. The records state that he had had fever on the night of the 24th, cried a lot, had a temperature of 101°, or otherwise less than l00.2°, and was teething. On physical examination, Christopher was alert and in no acute distress. His temperature was 100.7° and he had several new teeth. His left tympanic membrane was red with excessive fluid. The doctor diagnosed Christopher with left otitis media. He had several tiny white spots at the bottom of his jaw (gingiva) and was prescribed Amoxicillin.

Three days later, Christopher saw the doctor again. He was still alert, but irritable with a blister on his tongue. He refused to eat or drink, had very red gums, but no fever. His left tympanic membrane was better, the white spots were gone, and he had three new teeth. His temperature was 99.1°.

Petitioners' amended petition includes an allegation of a Table encephalopathy. 42 U.S.C. § 300aa-14, as modified by 42 CFR § 100.3(b)(2), states:

(i) An acute encephalopathy is one that is sufficiently severe so as to require hospitalization (whether or not hospitalization occurred).

(A) For children less than 18 months of age who present without an associated seizure event, an acute encephalopathy is indicated by a significantly decreased level of consciousness lasting for at least 24 hours.


Section I00.3(b)(2)(i)(D) states:

A "significantly decreased level of consciousness" is indicated by the presence of at least one of the following clinical signs for at least 24 hours or greater....:

(1) Decreased or absent response to environment (responds, if at all, only to loud voice or painful stimuli);

(2) Decreased or absent eye contact (does not fix gaze upon family members or other individuals); or

(3) Inconsistent or absent responses to external stimuli (does not recognize familiar people or things).


Section 100.3(b)(2)(i)(E) states:

The following clinical features alone, or in combination, do not demonstrate an acute encephalopathy or a significant change in either mental status or level of consciousness as described above: Sleepiness, irritability (fussiness), high-pitched and unusual screaming, persistent inconsolable crying, and bulging fontanelle....


Christopher's mother states in her affidavit and in the amended petition that on the night of January 24, 2000, Christopher became very ill and developed a fever. ¶ 3 of Mrs. Weiss' affidavit. She states that, on January 25, 2000, at the doctor's office, Christopher was not his normal happy, cheerful self. He was extremely sick and miserable. She concedes he was awake. ¶ 4 of Mrs. Weiss' affidavit.

Dr. Geier, who is a geneticist and an obstetrician, is not qualified to give a neurological diagnosis. (NOTE 1) Nonetheless, he has opined in his first affidavit, that Christopher had an acute encephalopathy beginning on the night of January 24, 2000, 14 days after receipt of his MMR vaccination based on the information in paragraphs 3 and 4 of Mrs. Weiss' affidavit. In his supplemental affidavit #1, he discusses in depth how MMR can cause acute encephalopathy and encephalitis. Those portions of his supplemental affidavit #1 discussing acute encephalopathy and encephalitis are hereby STRICKEN from the record as irrelevant since Christopher had neither an acute encephalopathy nor encephalitis. A child who is alert and in no acute distress does not have an acute encephalopathy or encephalitis. See Duncan v. Secretary of HHS, No. 90-3809V, 1997 WL 7529 (Fed. Cl. Spec. Mstr. Feb. 6, 1997) (without holding a hearing, special master dismissed case asserting measles encephalopathy because petitioner's affidavit contradicted contemporaneous medical records as to onset of symptoms and physician's report in support of petitioner was insufficient). See also, Bunting v. Secretary of HHS, 931 F.2d 867, 873 (Fed. Cir. 1991) ("the conclusions of a medical expert are not binding on the decisionmaker...."); Sternberger v. US, 401 F.2d 1012, 1016-17 (Fed. Cl. 1968) ("Even uncontradicted opinion testimony is not conclusive if it is intrinsically unpersuasive.").


NOTE 1: It is doubtful that Dr. Geier fulfills the American Medical Association (AMA) guidelines for expert witnesses: H.265-994 Expert Witness Testimony: (3)(a) "Existing policy regarding the competency of expert witnesses ... (BOT Rep. SS A-89) is reaffirmed, as follows: The AMA believes that the minimum statutory requirements for qualification as an expert witness should reflect the following: (i) that the witness be required to have comparable education, training, and occupational experience in the same field as the defendant; (ii) that the occupational experience include active medical practice or teaching experience in the same field as the defendant; and (iii) that the active medical practice or teaching experience must have been within five years of the date of the occurrence giving rise to the claim." American Medical Association, Policy Compendium (1999). In addition, the AMA "Code of Medical Ethics" states at 9.07 Medical Testimony: "Medical experts should have recent and substantive experience in the area in which they testify and should limit testimony to their sphere of medical expertise.... The medical witness must not become an advocate or a partisan in the legal proceeding." AMA Council on Ethical and Judicial Affairs, "Code of Medical Ethics" (2002-2003 edition). Dr. Geier's expertise, training, and experience is in genetics and obstetrics. He is however a professional witness in areas for which he has no training, expertise, and experience. Petitioners must seriously consider whether they want to proceed with a witness whose opinion on neurological diagnosis is unacceptable to the undersigned. When we reach the end of this case and the question of expert fees arises, there will be serious doubt whether Dr. Geier should be compensated for his time devoted to diagnosing an acute encephalopathy where none exists, and discussing (in his first supplemental affidavit) the MMR reactions of acute encephalopathy and encephalitis when neither is relevant in this case because Christopher, who was alert and in no acute distress on the 15th day after his MMR vaccination (when Dr. Geier opines his acute encephalopathy began on the 14th day, less than 24 hours earlier), could not possibly have had a Table acute encephalopathy or encephalitis. Moreover, three days later, he was also alert and in no acute distress. He was, however, miserable on January 25th with left otitis media, a fever, and new teeth, and on January 28th with a blister on his tongue and very red gums (with three new teeth).


In other vaccine cases, Dr. Geier's testimony has similarly been accorded no weight: Thompson v. Secretary of HHS, No. 99-0436, 2003 WL 221439672 (Fed. CI. Spec. Mstr. May 23, 2003); Bruesewitz v. Secretary of HHS, No. 95-0266, 2002 WL 31965744 (Fed. Cl. Spec. Mstr. Dec. 20, 2002); Raj v. Secretary of HHS, No. 96-0294V, 2001 WL 963984, *12 (Fed. CI. Spec. Mstr. July 31, 2001); Haim v. Secretary of HHS, No. 90-1031V, 1993 WL 346392 (Fed. Cl. Spec. Mstr. Aug. 27, 1993) ("Dr Geier's testimony is not reliable, or grounded in scientific methodology and procedure. His testimony is merely subjective belief and unsupported speculation."); Marascalco v. Secretary of HHS, No. 90-1571V, 1993 WL 277095 (Fed. Cl. Spec. Mstr. July 9, 1993) (where the special master described Dr. Geier's testimony as intellectually dishonest); Einspahr v. Secretary of HHS, No. 90-923V, 1992 WL 336396 (CI. Ct. Spec. Mstr. Oct. 28, 1992), aff'd, 17 F.3d 1444 (Fed. Cir. 1994); Aldridge v. Secretary of HHS, No. 90-2475V, 1992 WL 153770 (CI. Ct. Spec. Mstr. June 11, 1992); Ormechea v. Secretary of HHS, No. 90-1683V, 1992 WL 151816 (Cl. Ct. Spec. Mstr. June 10, 1992) ("Because Dr. Geier has made a profession of testifying in matters to which his professional background (obstetrics, genetics) is unrelated, his testimony is of limited value to the court."); Daly v. Secretary of HHS, No. 90-590V, 1991 WL 15473 (Cl. Ct. Spec. Mstr. July 26, 1991) ("The court is inclined not to allow Dr. Geier to testify before it on issues of Table injuries. Dr. Geier clearly lacks the expertise to evaluate the symptomatology of the Table injuries and render an opinion thereon.").

Petitioners may proceed in this case on their alternate allegations, a Table measles infection and causation in fact autism from either MMR or thimerosal-containing vaccines. Their allegation of a Table encephalopathy is hereby DISMISSED for failure to prove a prima facie case of an acute encephalopathy occurring within 5-15 days of Christopher's MMR vaccination.

IT IS SO ORDERED.

Oct. 9 2003

Laura D. Millman Special Master


=========================================================


This article is also important:

Thimerosal/Mercury
Vaccines and Autism

Updated: 09/20/2004

Thimerosal does not cause autism; nor does the MMR vaccine. This is the conclusion reached by The Institute of Medicine's Immunization Safety Review Committee in its report, Vaccines and Autism. (1)

The report states that "the body of epidemiological evidence favors rejection of a causal relationship between the MMR vaccine and autism" as well as a "rejection of a causal relationship between thimerosal-containing vaccines and autism."

The hypothesis that the MMR vaccine was associated with autism was originally proposed in a highly publicized series of case reports published in The Lancet in 1998. (2) The authors suggested that the onset of the symptoms of autism with gastrointestinal problems was temporally associated with the receipt of the MMR vaccine.

The IOM committee confirmed that this study by Wakefield and colleagues did not provide evidence that the MMR vaccine could cause autism. Indeed, in 2004, ten of the thirteen authors of that study formally retracted their suggestion of a possible link between MMR vaccine and autism. (3)

In a previous report in 2001, (4) the IOM’s committee had rejected any causal relationship between the MMR vaccine and autism at the population level—that means the MMR vaccine did not cause autism in the general population. However, the available evidence at that time was not sufficient to exclude the possibility that MMR could contribute to autism in a small number of children with a genetic predisposition to that disorder.

More recent epidemiological studies, which are assessed in the new IOM report, have consistently shown no evidence that the MMR vaccine was associated with autism. (5)

The IOM report described two studies by Geier (6) which had reported an association between MMR and autism as “characterized by serious methodological flaws and their analytic methods were nontransparent making their results uninterpretable, and therefore non-contributory with respect to causality.”

In other words, the studies by Geier could not establish a causal relation between MMR and autism because of their methods—such as using statistical measures incorrectly and omitting facts about their research approach. Similar problems were found in six other studies by Geier (7) and one study by Blaxill (8), which reported findings of an association between thimerosal-containing vaccines and autism. In addition, Geier’s expertise in neurological disorders has been questioned. (9)

Five large studies in Sweden, Denmark, the United States and the United Kingdom consistently found no evidence of an association between thimerosal and autism. (10) For that reason, the IOM’s committee favored rejection of a causal relationship between thimerosal-containing vaccines and autism.

This rejection differs from the conclusion of a 2001 report (11) by the same committee on thimerosal-containing vaccines and neurodevelopmental disorders.

The 2001 report stated that at that time the evidence was inadequate to accept or reject a causal relationship between thimerosal and the disorders of autism, attention deficit, and speech and language delay. The evidence now favors rejection of a relationship between thimerosal and autism. The current report did not evaluate the other disorders.

The IOM committee recommended that immunization schedules remain unchanged.

The IOM committee also recommended that research funding for autism be channeled towards more productive areas, such as the better understanding of the genetic causes of autism. (12)

References
1. Institute of Medicine. Immunization Safety Review: Vaccines and Autism. Washington, DC: National Academies Press 2004.

2. Wakefield AJ, Murch SH, Anthony A, Linnell J, Casson DM, Malik M, Berelowitz M, Dhillon AP, Thomson MA, Harvey P, Valentine A, Davies SE, and Walker-Smith JA. (1998). Ileal-lymphoid-modular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet, 351(9103), 637-641.

3. Murch SH, Anthony A, Cassen DH, et al. (2004) Retraction of an interpretation. Lancet, 363: 750.

4. Institute of Medicine. Immunization Safety Review: Measles-Mumps-Rubella Vaccine and Autism. Washington, DC: National Academies Press 2001.

5. Wilson K, Mills E, Ross C, McGowan J, Jadad A (2003). Association of Autistic Spectrum Disorder and the Measles, Mumps, and Rubella Vaccine: A Systematic Review of Current Epidemiological Evidence. Archives of Pediatric and Adolescent Medicine, 157:628-634.

Smeeth L, Cook C, Fombonne E, et al (2004). MMR vaccination and pervasive developmental disorders: a case-control study. Lancet, 364(9438):963-969.

6. Geier M, Geier D 2003. Pediatric MMR Vaccination Safety. International Pediatrics, 18: 108-113.

Geier M, Geier D 2004. A comparative evaluation of the effects of MMR immunization and mercury doses from thimerosal-containing childhood vaccines on the population prevalence of autism. Medical Science Monitor, 10(3): PI33-39

7. Geier MR, Geier DA. Thimerosal in childhood vaccines, neurodevelopment disorders and heart disease in the United States. J Am Physicians Surg. 2003;8:6-11 (See AAP's review of the article)

8. Blaxill M (2001). Presentation to Immunization Safety Review Committee. Rising Incidence of Autism: Association with Thimerosal. Washington DC.

9. U.S Court of Federal Claims. Office of Special Masters. October 9, 2003 (See footnote 1 on page 3).

10. Stehr-Green P, Tull P, Stellfeld M, Mortenson PB, and Simpson D (2003). Autism and thimerosal-containing vaccines: Lack of consistent evidence for an association. American Journal of Preventive Medicine, 25(2): 101-6.

Madsen KM, Lauritsen MB, Pedersen CB, Thorsen P, Plesner A, Andersen PH, and Mortensen PB (2003). Thimerosal and the Occurrence of Autism: Negative Ecological Evidence from Danish Population-Based Data. Pediatrics 112: 604-6.

Verstraeten T, Davis RL, DeStefano F, Lieu TA, Rhodes PH, Black SB, Shinefield H, and Chen RT (2003). Safety of Thimerosal-Containing Vaccines: A Two-Phased Study of Computerized Health Maintenance Organization Databases. Pediatrics 112(5): 1039-48.

Parker SK, Schwartz B, Todd J, and Pickering LK (2004). Thimerosal-Containing Vaccines and Autistic Spectrum Disorder: A Critical Review of Published Original Data. Pediatrics, 114:793-804.

11. Institute of Medicine. Immunization Safety Review: Thimerosal-Containing Vaccines and Neurodevelopmental Disorders. Washington, DC: National Academies Press 2001.

12. Muhle B, Trentacoste SV, Rapin I (2004). The Genetics of autism. Pediatrics 113: e472-86.

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