Monday, May 23, 2011

Missing Important Social Clues

Looking for Clues

Photo credit-topgold
Creative Commons License

One of the hallmarks of autism that is often cited is that autistics tend to miss important social clues. I must admit that this is something that we see often with our son, Buddy Boy (though he has made great strides in carving out "his own way" of initiating interactions).

Most people think that if they see someone that "doesn't get" typical social clues, that that must mean that that person is autistic. Well, not necessarily.

Take David Geier, for instance.

As the whole world now knows, David's dad, Mark Geier, had an emergency suspension of his right to practice medicine recently, due to the medical board catching up with his totally off the wall (and dangerous) antics in "treating" autistic patients.

As was patently clear from complaint against his father, David was up to his eyeballs in this, examining patients in his dad's office. David also had an appointment to the State of Maryland's Commission on Autism, which listed him as a "diagnostician". His one and only degree, an undergrad B.A. in Biology, in no way qualifies him for such a title.

Now, as anyone that follows politics in any part of the world knows, there are a certain portion of politicians and appointees that get caught up in scandals. And there is a certain way of conducting oneself that is expected in such situations. When one is caught up in a scandal, it may be OK to sit tight for a couple of days, to see if things blow over. But once you're actually charged with something, and if someone from the governor's office asks you to resign, you're toast. Your only acceptable course of action is to resign, as quickly and quietly as possible. Not to do so makes you look terrible, as well as causing needless embarrassment to the one who appointed you in the first place. Even really rich and important people know when to throw in the towel when they get caught.

Unfortunately, David Geier is the type of person my grandma would have said "...doesn't have the sense he was born with."

Once the whole scandal blew up, and the lengthy and detailed complaint made it obvious to all that this would not end well for the Geier's, one would think that David would have quit the autism commission. Well, he didn't.

Once he himself was charged with practicing medicine without a license, you would think that he would immediately recuse himself from any public position. Well, he didn't.

When David wouldn't/couldn't see the handwriting on the wall, he was asked to resign. As reported here, he refused.

So finally the governor of the state of Maryland had to come out and publicly fire him.

I'm thinking that the governor will not be so quick to appoint charlatans with transparently false credentials in the future. And much as I'd like to feel sorry for David Geier, I just can't.

Thursday, May 12, 2011

The Pigeons Have Come Home to Roost

Scales of Justice
photo credit-Eric the Fish
Creative Commons license

A medical license is a precious thing. Most people that have one have worked darn hard to get it. They've put in decades of education, paid a lot of money, and sat for numerous exams. They usually feel proud to have earned their diploma, and often don't think much about their medical license, once they've passed the appropriate exams (that is, they don't think about it until they get close to their mandatory re-certification exams every 10 years). The license is often viewed as just "one more hoop" that they have to jump through before they can practice.

But perhaps they should think about their license a bit more. While their diploma from their university and certificates from post-graduate training are (mostly) their own, their license represents the social contract that society has with members of the professions. A medical license granted by the government gives one broad authority-you get to set up shop in your field, admit patients to the hospital, charge fees that are often paid (at least in part) by insurance companies and the government, and have people allow you to cause them all sorts of pain and embarrassment, all in the pursuit of curing or alleviating whatever ails the patient that walks through your door. The state allows members of the profession (collectively) to have great say in educational standards, and grants them at least some exclusivity (keeping competition from untrained persons suppressed, which also protects the public). In return, members of the profession have obligations towards the state/community in which they are licensed. They are to be honest, have a positive obligation to keep current in medical knowledge in their field, not practice in areas in which they are not trained, put the patients' welfare before their own, and always strive not to harm patients.

While it is upsetting when people in the community are hoodwinked by, say, a dishonest roofing contractor, people get more upset when a doctor acts unethically. Even in today's busy world, where people see multiple different doctors, the medical encounter between patient and physician remains an intensely personal one, "protected" by this social contract. It is because of this that people get more upset.

Fortunately, the profession, and the pubic, have a way of "righting the ship" when things go wrong. State medical boards are usually mainly staffed by physicians, with a few members of the general public. All of these members are usually appointed by the governor of the state, in a (fairly) non-political manner. The only compensation usually received typically is a small per diem to cover travel expenses to the capital city (which is usually where meetings are held).

In any profession there will be frauds and crackpots. That being said, my experience is that the vast majority of physicians have worked very hard to get where they are, and really seem to be motivated to do the best for their patients. But in order to retain the trust of the public it is necessary that those who practice fraudulently are weeded out.

It is a big deal to take someone's license away. As I mentioned, they have spent decades of their life preparing to sit for their exams, and invested hundred's of thousands of dollars, before ever seeing their first paying patient. Thus investigations of impropriety usually take time. A medical board is not in the business of stifling innovative practice, and must guard against disciplining doctors whose only crime is being smarter than the norm. But the board IS charged with protecting the public, and thus has to identify and discipline those who ignore their responsibility to practice in accord with scientifically sound practices, and who would view their license as merely a cash generating vehicle.

The Maryland State Board of Physicians has suspended the medical license of Mark Geier, M.D., in an emergency measure to protect the public while he has a hearing before final disposition. In their 48 page report, the Board details how Geier practiced bad medicine (making mis-diagnoses of precocious puberty without standard physical exam or laboratory findings being documented), performed fraudulent research (no consent forms, totally improper in-house IRB committee, poor research design and execution), and allowed his untrained and unlicensed son to practice medicine in his office in his absence. Kathleen (Neurodiversity Weblog) and Prometheus (A Photon in the Darkness) both have very good posts detailing a lot of the bad things he's done, and why he richly deserves to have his license yanked.

Reading through this report, one thing is eminently clear. Mark Geier will never practice medicine in Maryland again. Boards don't get this much damning evidence documented, and then let someone off with a slap on the wrist. While his final discipline may read something like "License revoked with no re-application for at least 5 years", there is no way that any future board will let him get his license back. Not after this.

In regards the other states that Geier has licenses to practice medicine, his license remains active at this time. That (in most cases) will automatically change once his permanent suspension or revocation action takes effect. Most state boards automatically put the same restriction on your license as other states do, unless you can prove to them that you don't deserve it. I am not aware of anyone ever overturning one of these automatic revocations. So while he technically can still practice somewhere else, one can take solace that that option will soon close for him.

While this SHOULD put an end to those spinning wild theories and foisting wholly unproven treatments on autistic patients, it won't. But perhaps it might give a few of those unethical practitioners that have medical licenses just a bit of pause now, as they realize that perhaps their own hucksterism might have the light of truth shined on it next.