Confused offering adds little insight

Elspeth McLean reviews A History of the `Unfortunate Experiment' at National Women's Hospital.

A HISTORY OF THE `UNFORTUNATE EXPERIMENT' AT NATIONAL WOMEN'S HOSPITAL
Linda Bryder
Auckland University Press, $45, pbk

More than 20 years after the commission of inquiry into the way carcinoma in situ of the cervix was being treated at National Women's Hospital, a comprehensive study of this controversial event would be welcome.

Unfortunately, this confused offering from Auckland University medical historian Prof Linda Bryder is not that book.

The 1988 inquiry, led by then Judge Silvia Cartwright, followed a 1987 Metro magazine article from Sandra Coney and Phillida Bunkle about what was dubbed (by University of Otago Prof David Skegg incidentally) " the unfortunate experiment" at National Women's Hospital.

Their concern was that in 1966, Assoc Prof Herb Green began an experiment in which he decided to withhold conventional treatment from women who had carcinoma in situ (CIS).

His belief was that it did not proceed to invasive cancer if untreated.

Coney and Bunkle, informed by a 1984 research paper by four of Green's colleagues, contended patients were not aware they were part of this trial.

Also, those who were treated inadequately were at considerably greater risk of developing invasive cervical cancer than women who were fully treated.

Bryder considers the social context of the inquiry, saying that it was not just about Green's research and his approach to his female patients, but the "culmination of a clash of ideologies and approaches to medicine, with women's bodies having become highly politicised".

She contends Green was trying to avoid women having unnecessary surgery and was not out on a limb because at that time there was much international controversy about the best way to treat CIS.

What she does not explain is whether any international gynaecological academic heavyweights lined up at the inquiry to defend his behaviour.

If not, why not?Bryder wants us to accept that Cartwright, in finding there had been an experiment and that women were harmed because of it, was wrong.

There is, however, little about the nuts and bolts of what happened at the inquiry.

Do the snippets we get from Bryder accurately reflect what went on?The women who were Green's patients receive scant attention.

Her account of the experience of the most well known of them, Clare Matheson, is inadequate and makes her later radiation treatment and hysterectomy sound almost trifling. She also mistakenly implies Matheson went on to have four children after coming under Green's management.

Matheson already had two children before she became Green's patient, and one while in his care.

A small error, perhaps, but one which has the ability to influence the reader's view of Matheson's treatment.

Sometimes the author's use of secondary sources rather than original ones is frustrating.

In a section on the media coverage she includes writing from Valerie Smith about her attempt to challenge the findings of the inquiry in the High Court, but I could find no evidence Bryder had gone back to the actual court decision.

Why not?Bryder's reliance on written material also seems curious, given her wish to place the events in a social context and the fact there are still people living who were closely associated with the inquiry (including Otago professors Skegg and Charlotte Paul) and the events leading to it.

Valid points are made about the risks of over-selling the benefits and under-explaining the risk of over-treatment in cancer screening programmes, but although she devotes a chapter to population-based cervical screening, Bryder never evaluates New Zealand's programme.

I look forward to a future history which might thoroughly examine this event from a variety of angles and clarify some outstanding issues, including how many women were affected.

Since controversy and conspiracy theory claims over the issues seem very much alive, perhaps it would be desirable for such a work to come from beyond Auckland or Otago to avoid any possible suggestion of an academic shoot-out between the universities.

- Elspeth McLean is a Dunedin writer.

 

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