If there's a single statement that everyone who works in the field of autism can agree on, it's that there is so much that we still don't know.
Medical professionals can't even definitively say why more children are being diagnosed as having autism or similar developmental delays, much less agree on the best courses of treatment and therapy. Yet all of us who work with families of children with autism can't help but be affected by the emotions of desperate parents.
This month, I go before an administrative law judge to appeal a decision by the Maryland Board of Physicians to summarily suspend my medical license related to the treatment of children with autism. I wish that I was permitted to respond to the various allegations in detail, but the board's privacy restrictions make that impossible. (For the record, I have tried to waive my privacy rights and asked that my appeal be opened to the public, but have thus far been denied.)
In my more than 30 years of practice, since completing my medical training at the Johns Hopkins Hospital, I have spent thousands of hours talking to the families of children with autism — evaluating their condition, publishing research in peer-reviewed journals and trying to add to the medical profession's broad base of knowledge about autism. I understand that not everyone agrees with some of what our research has concluded, just as I don't necessarily agree with what other physicians have written. In the end, finding answers through continued research is how science moves forward.
Over the years, our work has helped to uncover that a significant number of children with autism have remarkably high levels of male hormones in their blood. We have found that many of these children with high male hormone levels display behaviors that are among the most challenging to deal with in autism, such as unprovoked and extreme violence, to themselves and the people around them, and an inability to sit still for beyond a few seconds. These behaviors make it all-but-impossible to engage children in the more well-known forms of behavioral therapy.
In young children without autism, these levels of hormones prompt a diagnosis of precocious puberty, and physicians often use medication to reduce the hormone levels to those that are more appropriate for the age group. We have begun using a similar approach for children with autism who display high levels of male hormones, prescribing a drug called Lupron. The drug — supported for use in children by the American Academy of Pediatrics — suppresses the male hormone levels without leaving any lasting changes to the body's ability to manufacture those hormones in the future.
For a large percentage of the hundreds of children we have treated using this therapy, the results have been tremendous. Countless parents have told us that their families' lives have been transformed by the use of Lupron — particularly because the alternative for many of these children has been either the off-label use of dangerous anti-psychotic medications or institutionalization.
Let me be clear. Lupron is not a "cure" for autism, nor is it the appropriate therapy for all children with autism. My fellow physicians and I turn away many families because their children are not suitable candidates. But for many children with high levels of male hormones — particularly ones who display extremely violent behavior — we have found Lupron to be a successful means of reducing those symptoms. We have published peer-reviewed research on our work, and we intend to continue to do so.
Some critics have charged that there's little oversight for our use of this therapy, and that we are profiteering off of desperate parents. But they neglect to mention that physicians employed by insurance companies are signing off on what we're doing.
Pharmaceutical companies charge thousands of dollars per month for Lupron treatment — money that, for virtually all of our patients, is covered through medical insurance. Not surprisingly, the insurance companies demand that their own doctors review extensive blood tests and other analyses before signing off on reimbursements for Lupron. And the insurance companies require regular updates to those blood tests to assess whether continued injections are medically justified.
These blood tests are performed by an outside national lab, and we only consider prescribing Lupron for patients whose hormone levels exceed the age-specific range set by that company. Much of the money for both the drugs and the blood testing goes straight to drug companies and laboratories, not my medical practice.
Throughout my medical career, my top priority has always been the welfare and treatment of my patients. Like every other medical professional who has treated children with autism, I wish there was more that we understood. So many of us are working to build on the body of existing research, and I am honored that my work has resulted in a successful therapy for many families. All that I ask is to be permitted to continue my work and assist children and their parents in the quest to find answers.
Dr. Mark Geier has a medical degree, a doctoral degree in genetics, is board certified by the American Board of Medical Genetics as a genetic counselor, is a fellow of the American College of Medical Genetics and is a fellow of the American College of Epidemiology. He is a former assistant professor at the Johns Hopkins School of Medicine. He is licensed to practice medicine in 11 states and lives in Silver Spring. His email is firstname.lastname@example.org.