Banned, Banned, Banned
It seems that there is still considerable confusion within the rosacea community over Geoffrey Nase's status with the three main rosacea boards, given his claims to have left each voluntarily. Some of his followers still honestly believe that he can and will return, so perhaps we had better look at the facts.
Nase resigned from RS on June 11, 2005, to join the new Rosacea Forum at rosaceagroup.org. This was his second resignation from RS. However, he still kept trying to post, and in early July, he contacted a moderator to ask if he had been permanently banned. When told that the mods were indeed going to hold him to his resignation, Nase accepted that it was time to move on. Since then, he has mainly left RS alone, apart from bizarre boasts that he was going to shut the group down and/or persuade Yahoo to hand it over to him. (Neither course was ever remotely possible.)
In September 2005, Ed, the owner of the ESFB board, ordered Nase to leave and terminated his membership, then shut down the whole board for several weeks. When it reopened, a loophole meant that guests could post. Nase took advantage of this and resumed posting. (His posts from those weeks all show Guest status.) When that loophole was closed, Nase got a friend to forward his messages. When again ordered off the board, Nase allegedly threatened to sue Ed, so the Rosacea section was closed down on November 22 and has still not reopened. Determined to force his way back onto the rest of the board, Nase signed up again on December 24, but it's a two-stage process and Ed refused to activate Nase's membership. This aborted attempt to rejoin is recorded in the list of members.
When questioned on the Forum about how he came to leave ESFB ('Quote from ESFB about Neocutis', Jan 13, 2006), Nase declared: "I bowed out graciously and Ed did ask me to take some time off so that the other boards could fluorish again. I bowed out like a gentleman. ..." One of the Forum moderators replied: "Last time I talked to Ed, he said you were banned from ESFB and that you were the one that requested the Rosacea section to be closed. Maybe I'm wrong.. sorry if I am, just what I heard." Well, it's what we heard, too.
The January ban came after innumerable warnings and temporary bans. Because the group was created for him, Nase could never accept that he should be subject to the same rules as ordinary members. Moderators' requests that Nase should stick to writing about science and refrain from posting aggressive and abusive messages fell on deaf ears. The final straw came when Nase was caught using his scientific posts to attack his enemies, faking 'evidence' to scare people away from treatments he disliked. That was too great an abuse of his privileged position and the mods voted first for a one-week suspension, then for a permanent ban.
Nase has routinely used posts about science to boost his reputation or rebuke critics, and many of his 'break-through' posts announcing the next great hope were timed specifically for that. On January 9, 2006, he stepped things up by starting a thread titled "The Biggest Treatment Secret in Rosacea", built around 'proof' that Plaquenil (hydroxychloroquine sulfate) could "knock severe rosacea back down to pre-rosacea and mild rosacea ... within 30 to 45 days". The anti-malarial would be particularly good for those who had proven resistant to the usual rosacea therapy, he claimed, because with Plaquenil, "short term treatment can completely break the vicious rosacea cycle".
Although some dermatologists do prescribe anti-malarials as an option in more severe treatment-resistant cases of rosacea, to the best of our knowledge, Plaquenil is not normally one of them. Furthermore, Nase didn't mention that one of the main dangers with Plaquenil is the risk of irreversible retinal damage, which means that it might not be a good choice for the large numbers of rosaceans who also have ocular rosacea. But Plaquenil does have a solid history of relieving rheumatoid arthritis and mild forms of discoid and systemic lupus erythematosus (SLE), so can often work surprisingly well with patients who have border-line diagnoses, or who actually have lupus, but are misdiagnosed as having rosacea.
On the internet, one of the new Forum mods looked up the original treatment report on which Nase had built his post and was puzzled to find that, far from having been written by "a treatment resistant rosacea sufferer with severe redness, severe papules and severe burning (who) has been treated by all the standard medications and laser treatments for 9 years without any improvement" and was now completely cured - as Nase had claimed - the patient reported that Plaquenil had helped lighten a bright red blotchy cheek rash and made the pain and fatigue of fibromyalgia more manageable. "I, supposedly, don't meet enough criteria for a lupus diagnosis; but, it's always in the back of my mind. ... Two different dermatologists said it was rosacea, but none of the medications for that ever did anything for me."
(Forum thread 'Plaquenil', March 3, 2006)
Text of the 2003 remedyfind.com review appears in full in post #40 of the Rosacea Forum's 'Plaquenil' thread:
This was someone who had apparently been diagnosed as having rosacea on the strength of a cheek rash, but who thought it was instead some form of lupus. There was no mention of severe burning, papules, or of any laser treatments. Someone had rewritten this one report and spun it into a great frothy bubble of hope for the treatment-resistant, and not even the mod's cautionary post was enough to burst that bubble. Several rosaceans immediately went onto Plaquenil to test the 'wonder drug' for themselves.
When Nase launched his Plaquenil thread, he was greatly in need of a boost. Two days earlier, Peter Waters had returned to the board, five months after skewering Nase's reputation by lampooning the incredible honors supposedly bestowed on him by the Indiana Medical Licensing Board, and by letting other members see a batch of astonishing emails in which Nase mocked Waters and his pet topic, red light therapy. There was no way the two men could co-exist on the board again and over the following week, Waters clashed repeatedly with Nase and his closest supporters.
Dr. Vicky - Nase astonishes yet another medical expert
One of the battles had its roots in Nase's heavy promotion of Lyrica (pregabalin) on the Forum the previous December. A young Canadian carried the topic across to ESFB, expressing bitter disappointment that he could not afford the drug. (December 22, 2005, Facial blushing section, 'What a TEASE!') Trying to help, a US pharmacotherapy specialist who sometimes posts on ESFB under the name 'VickyGirl', explained that Lyrica "is a very close cousin of Gabapentin", and Neurontin, the generic form of Gabapentin, would probably be covered by his medical insurance. Nase, banned from ESFB, got a supporter to post his defense of Lyrica, which was, he explained, "a completely different molecule and has a completely different mechansim of action". "Based on about 5 years of anecdotal failure reports, neurontin iis a complete waste of money for our disorder ..." (Please check the thread to read these messages in full.)
VickyGirl quickly but courteously demolished Nase's post, pointing out the garbled thinking and lack of evidence, ending:
""Anecdotal failure reports" is just a big word for "hearsay". I find it almost appalling to recommend or condemn a drug as a "waste of money" based on anecdotal data. Any attorney would agree. ... I consider it my responsibility to never mislead other readers by writing "absolutes" and misleading others to take my opinions as fact. I urge others to not confuse a Ph.D. with an M.D. Ph.D.'s are extremely capable and knowledgeable in the theoretical arena and may study the effects of drugs on human and animals or "in-vitro" which means in a lab. They cannot diagnose, prescribe or treat patients for any disease or condition. M.D.'s specialize in the diagnosis and treatment of HUMANS. It's quite unfortunate that the public at large will confuse one profession with the other. Thanks, Dr. Nase for your input. I am absolutely sure that your advice is well-meaning. As is mine."
Nase took his revenge a couple of weeks later over on the Forum, after Waters had written that although Lyrica "sounds very promising, and might prove to be a great help to some rosaceans", it was of concern that a pharmacology specialist had recommended "a degree of caution" about the drug. (January 11, 2006 'Another view on Lyrica') Waters posted a link to the 'What a TEASE!' thread and urged anyone interested in Lyrica to check out the relevant posts. Nase went straight for the jugular: "Please do not listen to everything on the Internet -- Especially non-existent credentials. There is one female who attempts to explain that it is just Neurontin, but she has so many wrong medical sentences that she certainly could not be a Pharmacologist."
At the same time, discussion of the much-hyped Neocutis cream had reached ESFB, with VickyGirl pointing out that 'prescription strength' was a contradictory term for an OTC cosmeceutical (thread titled 'this forum is getting realy boring, used to be intresting'). When this debate was taken back to the Forum, Nase said he would always offer corrections "when an important drug is being discussed and someone self proclaims to be a professor of Pharmacology when they clearly cannot be based on basic science and medical innaccuracies that are taught in first year medical school" and he dismissed as "a 10 page diatribe" the measured, 8-paragraph post (4 quotes from his message, each with an answer) that had done him so much damage. ('Quote from ESFB about Neocutis')
The woman who was relaying messages for Nase at the time rushed in to give her opinion: "This woman's advice is more harmful than any rosacea treatment I've ever come across", which was ridiculous, when the advice was simply that someone who was unable to afford one particular neuropathic pain medication might prefer to try another that was cheaper and more commonly prescribed. It was also foolish, given that Dr. Vicky was genuine! Two rosaceans with no involvement in the board battles vetted her credentials. They looked up the hospital's phone number on the White Pages and spoke to the Human Resources department, then emailed her at the hospital and received immediate replies. They checked that she was currently registered with the appropriate pharmacy body, and even saw the two licenses in her name, held by the state medical registry. Dr. Vicky is also working as an assistant professor, mentoring doctorate students.
No wonder she had no patience for the usual hype about imminent wonder cures, and no wonder Nase was so desperate to insult and discredit her in public - hardly the behaviour of someone who knows how to work with professionals.
The biggest battle occurred over the safety of red light or Low Level Light Therapy (LLLT), which includes a wide range of LED and fluorescent lamps generally referred to as "skin lamps". These are increasingly being seen as a safe, gentle and fairly inexpensive anti-inflammatory treatment for conditions such as rosacea. Nase's friend and most faithful supporter, Jonathan Gamache, posting under the pseudonym "The Rosacea Champ", declared that a red LED lamp had made his flushing much worse. (Forum January 8, 2006 'Update on Super-Duper LED array') When Waters asked for details of the lamp supposedly used, Gamache posted a link to a fluorescent lamp. Gamache had previously posted about his three-month experiment with LLLT and every time he had supplied a different description. (August 6, 2005 'debunking thread') (This was much like Nase himself, who had repeatedly confused the two systems in his own posts.) Since self-help groups depend on honesty, there is no worse offence than concocting fake treatment reports, so Gamache was placed on yet another temporary ban.
Gamache's history of providing Nase with unquestioning but questionable support dates back many years. In December 2002, when Nase was in the thick of battles on the Rosacea Knowledge board with the MD who was his main sparring partner, someone set up a fake identity as 'Dave Trump, medical student at the University of Washington'. After a couple of rude and sexist posts to the physician (eg, "You want to play with the big boys... and flapping your gums with an "M.D." behind your name just ain't good enough"), the facade slipped in July 2003, when Gamache used his own email address to post a flattering message to Nase ("Good to see how active you've been with the RK board as of late - I always get excited when I see a post from you") but accidentally signed it "Dave Trump". The 'medical student' was never heard from again.
(Rosacea-knowledge group, messages # 668, 2417 & 2426.)
The LLLT Controversy
This article has been amended in line with Dr. Crouch's later clarification. Please see Nase's Latest Rebuttal & Dr. Crouch's clarification
Nase wanted a quick killer-punch to drive Waters off the board, so on January 21, in a new thread titled 'LLT and LED-induced 1st degree burns and flushing', Nase announced that LLLT was a dangerous treatment that had already caused damage to a large number of rosaceans. Despite the terrible harm being caused, certain unprincipled people were promoting the sale of lamps for commission. The personal attack was unmissable, and later in the thread Nase actually stated that Waters was on the Dermalux payroll, despite Waters producing a statement of rebuttal from the director of the firm concerned.
Nase claimed to have received "well over 110 to 125 reports of blister skin, 1st degree burns, and increased flushing" and said that many well-known laser physicians had privately told him about "LED and LLT-induced permanent side effects". In fact, one UK laser physician had just seen a rosacean with "a first degree burn and the flushing, redness and burning may never be treated fully". This post caused considerable alarm, but also widespread astonishment, given that LEDs are a non-thermal source of light. As one poster later pointed out, "you have to be a complete idiot to get a 1st degree burn from LEDs. Its like getting a paper cut from a balloon".
But a few minutes later, Dr. Peter Crouch posted in Nase's support, saying that just that week he had seen two patients who'd harmed themselves by using home-built "super bright Infra red LED arrays". This was even more surprising, given that, as one of the mods quickly pointed out, most people with skin burns would presumably go straight to their GP or local hospital, not to a laser specialist. With two such patients chancing to turn up at the same clinic in the same week with damage from similar home-made LED devices, logic would suggest that hundreds of similar cases must be occurring throughout the UK and the USA, with LED burns being regularly reported to other doctors, yet no one else came forward.
If the lamps were so dangerous, one would expect to see a wave of complaints on the internet, in the media, on consumer and health programmes, and yet no one had seen anything of the kind. No safety warnings have been issued, and it was believed that the incidents had not been reported to the medical authorities who monitor such things. The suspicion was that if Nase had really received well over a hundred reports of LLLT injuries, he would have rushed to give a copy of the complaints to the FDA, the AMA, and other regulatory bodies.
Over the next few days, David Christian, a moderator of the group who had built his own LED array and had been greatly helped by it, made numerous attempts to get the technical specifications of these devices, such as wavelength and energy output, but Nase rebuffed it as irrelevant. "Every single LED and LLT will cause dramatic increases in blood flow. Every one, every wavelength, and every self made system."
Angered, Christian reproduced quotes from previous posts by Nase, including one from January 10, 2006 ('Light Therapies and how they work'), where Nase had written about Christian's home-built LED systems in a light-hearted mood:
"This is the way to get to better treatments. I will need to borrow the books as we used many systems -- one light, combination light, etc. I will also try to give you the range and the medical indication. With this information David, I would expect nothing less than a time machine built in your garage!"
Yet Nase was now claiming that in the eleven days after that post, he had received 110 - 125 personal emails from rosaceans burnt by LLLT. And, of course, there was the refusal to provide any kind of evidence.
Suspicions that this was part of a purely personal vendetta deepened when Waters at last joined the thread and reproduced quotes from an email Nase had sent just days before, threatening to set up two hate blogs against him and making other claims Waters dismissed as "absurd and pathetic". When Nase retaliated with a choice bit of character assassination, the mods were polled on whether or not he should be excluded from the board yet again.
Nase's Last Post
On January 27, Nase offered as a parting shot his 'Last Post on Topic & then Rosacea Sufferers Make up Mind'. Again, he attacked LLLT and its supporters, but for the first time, he offered "evidence" in the form of "facts from a Bio-physics site on the 'benefits' of both these machines". Although the extract stated that "irradiation with laser light" caused biological effects including angiogenesis and increased blood flow, Nase presented this as proof against the gentler red light therapy. When a new member pointed out the key word 'laser', Nase claimed it was a typo. He was writing about LLT and LEDs, but had typed the wrong word. Unfortunately for Nase, another rosacean ran a google search for the "bio-physics site" Nase quoted from, and found that it was a web site on horse health! The quote clearly stated that the material was written about LASERS. Since Nase had obviously just cut and pasted the block of information from the net, the presence of the word 'laser' could not be dismissed as a typo. Nase had lied again.
In the four months since Nase's infamous 'LLT and LED-induced 1st degree burns and flushing' thread, there has been no flood of reports from burn victims, and most rosaceans have come to the conclusion that it was a last, desperate ploy by Nase to discredit Waters and force him off the board. Nase is long gone from the Forum, but Dr. Crouch stays on, freely offering helpful advice on laser and IPL technology. He is also generously providing free or discounted treatments to several prominent members of the online rosacea community, even though his charges for treatment are already below those of his main competitors.
Nase had written about his close friendship with Crouch and plans for future business collaboration; for example, this post Nase put up on the Forum in the same burns thread: "Crouch and I are good friends and we have discussed everthing that has happened in detail up front. He knows whats happening. We already have a UK party set up this summer when I travel out to Dr. Crouch to perform a laser study to help enhance results." However, Crouch has never made any such claims.
Although it is widely agreed that Dr. Crouch is both a gentleman and an asset to the board, the mystery of his involvement in the "LED burns fiasco" remains. The sudden appearance on his doorstep of two patients claiming to have been burnt by home-made LED arrays in the very week Nase needed backing up may seem unlikely, but there is another possibility no one seems to have considered. What if the patients were lying? That in itself may seem improbable, but they didn't bring their LED arrays into the clinic with them, so there was no evidence to back up their stories.
It wouldn't be the first time Dr. Crouch has been put into an embarrassing situation of this kind. Last August, two of his patients were caught plastering the rosacea groups with over-hyped praise for Crouch. Since they had earlier filed balanced statements about the results of their treatment, other rosaceans became suspicious and asked the physician to set things right. Crouch publicly washed his hands of them, explaining that they had been "making outrageously optimistic claims about "total cure" and number of sessions etc. and were, quite frankly, embellishing their experiences". (ESFB thread 'Public Announcement by Dr. Peter Crouch', reply #5, August 3, 2005 & similar posts on the Forum)
Two Poor Victims
The two burns victims were a curious echo of one of Nase's favourite themes, that of two unnamed victims no one else can ever find. Last summer, when Nase was wrongly attributing the Debunking web site to Chuck Young, he published on his own web site an astonishing attack on Young, claiming that "two females" (Nase continually refers even to mature women as 'females' or 'girls'.) had appealed for his help "after having horrible reactions" to ivermectin. "One female experienced extreme gastritis with bleeding" while "the second female" developed an arm infection and cellulite formation. Nase claimed that Young had been reported to his state supervisory board, but Young dismissed the whole thing as a bizarre fantasy and said that he had neither heard of the two women in question, nor ever been in trouble with any Veterinary Medical Board.
In the 'LLT and LED-induced 1st degree burns and flushing' thread, Nase posted this account of why he had suddenly spoken out against the new technology:
"... Let me just give you one example of the situation I am in. Dave Flemming has been touting a DMSO + Fluconazole cure for over two years. Topical DMSO on rosacea skin and eyes is as caustic as diluted hydrochloric acid. In my lab we use two pairs of thick gloves whenever we use the DMSO ampoules. NO ONE reported the dangerous side effects for over a year. Not one person. The main reason -- anytime a person even hinted that DMSO may be dangerous he would post long rebuttals that would tear the person down. So everyone stayed away from warning all unsuspecting rosacea sufferers from this bogus cure. I even kept my mouth shut because I did not have the energy to deal with the aggressive debates that would ensue. Freakin shame on me. Three people have damaged their corneas with two confirmed corneal melts which will require major eye surgery. I said nothing and I feel responsible for doing nothing."
In fact, Dave Fleming started proclaiming DMSO + Fluconazole as "The Cure" on Rosacea Support on April 29, 2003. Members challenged Fleming immediately, but mainly over his paranoid rants against his enemies, and the way he rudely attacked anyone who disagreed with him. It is true that Nase said not one word against DMSO until 16 months later, but on June 5, 2003 the board's resident MD came forward and posted a warning that DMSO was a significant histamine releaser that caused flushing, and promoted inflammation when applied to irritated skin. The topic of DMSO kept coming up, and occasionally being challenged, for a long time before Nase joined in, eg by one rosacean, who wrote: "It appears to be caustic. I can see no reason to use it." (RS, January 11, 2004). Despite that, Brady Barrows tested it on himself with his doctor's approval, after being told by a pharmacist that it was "a benign treatment" (RS, September 3, 2004), and Perry Jones said his (pharmacy) professors were amused that he was trying it. (RS, August 24, 2004)
In his RS post of September 8, 2004, Nase wrote:
"I have been contacted by two young females who tried Dave Flemming's topical DMSO formulation. They contacted me about visual disturbances that were verified by their eye specialists. Both females experienced moderate to severe corneal thinning and partial (hopefully reversible vision loss). ... For those of you who do want to go ahead and try DMSO out, please do not apply to the centrofacial area. Try spot treating on cheeks or forehead."
Since then, the two people have become three and the "moderate to severe corneal thinning" has changed to "corneal melts", but otherwise, nothing has changed. No one we contacted had ever heard anything else about these mystery victims. They'd vanished ... just like all the rest.