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Feature Autism research

What makes an expert?

BMJ 2007; 334 doi: http://dx.doi.org/10.1136/bmj.39146.498785.BE (Published 29 March 2007) Cite this as: BMJ 2007;334:666
  1. Brian Deer, journalist
  1. London

    Autism activists are behind a journal's decision to retract a paper claiming a preservative once routinely used in vaccines is responsible for the condition. Brian Deer examines the facts

    Last October, Autoimmunity Reviews published online the draft of a seven page paper by reporting laboratory and clinical tests suggesting that thiomersal, a mercury based preservative once routinely added to most vaccines, was the main culprit for a sharp rise in diagnoses of behavioural disorders.1 The paper was written by Dr Mark Geier, a self employed American geneticist, and his son David. The pair also reported treating autistic children with a hormone product, leuprorelin acetate, which is sometimes prescribed for precocious puberty. They claimed that the drug produced “very significant overall clinical improvements” with “minimal” adverse effects.1

    But even before the journal posted its finalised contents page, Kathleen Seidel, an autism activist in Peterborough, New Hampshire, who runs the website neurodiversity.com, criticised the paper in a 2500 word email sent to the journal's editors-in-chief, Yehuda Schoenfeld of Tel Aviv University, and Eric Gershwin of the University of California, Davis, and copied to all 42 members of the journal's editorial board.2

    One of Ms Seidel's complaints concerned the Geiers' apparent institutional review: “The seven-member IRB [institutional review board] consists of Mark and David Geier; Dr Geier's wife; two of Dr Geier's business associates; and two mothers of autistic children, one of whom has publicly acknowledged that her son is a patient/subject of Dr Geier, and the other of whom is plaintiff in three pending vaccine injury claims.”

    According to Ms Seidel, neither editor responded to her email, despite several approaches to them. US Federal Court records show that Drs Schoenfeld and Gershwin have both been retained as experts for claimants in vaccine litigation.

    The Geiers' paper in Autoimmunity Review has now been retracted, but I have been unable to discover the journal's reasons for retraction and the editors have not responded to my emails and phone calls.

    Professor Graham Hughes, formerly of the Rayne Institute at London's St Thomas's Hospital, and a member of the journal's board, was also unable to help. “All I know is that I got a rather heated 20-page email from a lady,” he said when asked for his comments on the retraction. “I really don't know what it's about.”

    Meanwhile on the net, the retraction has been greeted with glee by autism activists. Ms Siedel is a prominent contributor to an “autism hub” of websites, which has sprung up in the past two years to challenge the concept of autism as a disease that needs to be cured. The neurodiversity movement contends that hard wired behavioural difference should not be the basis for discrimination, or necessarily drug treatment.

    “Neurodiversity is both a concept and a civil rights movement,” says one of many definitions on network sites.3 “In its broadest usage, it is a philosophy of social acceptance and equal opportunity for all individuals whose neurology differs from the general, or neurotypical, population.”

    Janssen Pharmaceuticals, which produces risperidone, a drug used to treat autism, is well up the activists' suspicion list for allegedly fuelling the rise in diagnoses of autism. But currently at the top of that list are the Geiers because of their high profile support for the fringe theory that mercury in vaccines causes autism.

    The Geiers operate various organisations from their private address in the Maryland suburbs, including the Institute for Chronic Illness and the Genetic Centers of America. Neither of these organisations has listed telephone numbers or web addresses.

    The Geiers have also been hired to appear in hundreds of vaccine related lawsuits. In these, too, they've come under fire, with judges handing down stinging criticisms. Three years ago, a Washington vaccine court declared Mark Geier to be “a professional witness in areas for which he has no training, expertise and experience,” citing numerous earlier cases in which he was criticised from the bench.

    However, such criticisms have apparently had little effect on the boards of some biomedical journals. A string of journals have now carried articles by the Geiers, with Mark Geier reviewing a book on the cause of autism in this month's Lancet Neurology.4

    But the Geiers and the journals that have published their work have reckoned without Ms Seidel. After her emails to Hormone Research last summer, its editors withdrew a statement on a paper which affiliated David Geier with George Washington University, where Ms Seidels inquiries found he was apparently a masters student for just two terms.5

    Questions then emerged from Ms Seidel's analyses of a paper by the Geiers in Medical Science Monitor.6 Chunks of text from the article were alleged to be identical to published material from a researcher at the Centers for Disease Control and Prevention, which were interspersed with parts of an old Geier paper.

    “Although the byline notes indicate that Dr and Mr Geier contributed to study design, data collection, statistical analysis, data interpretation, manuscript preparation, and literature search,” Ms Seidel says, “there is no indication that their ‘data collection' might have entailed collecting data from another researcher's study, or that their ‘manuscript preparation' might have entailed merging that study with an article they had previously written.”7

    Although there may be reasonable answers to the queries raised by Ms Seidel, my emails putting questions to Mark Geier went unacknowledged last week. Ms Seidel's allegations have also highlighted potential problems with the review processes of biomedical journals. However, the response from academics is not hostile. “I'm very impressed by the scholarship in the neurodiversity.com website,” says Simon Baron-Cohen, director of Cambridge university's Autism Research Centre. “I welcome the debate being widened, now that science is transparent on the internet.”

    Footnotes

    • Competing interests: None declared.

    References