THE CARTWRIGHT PAPERS
Essays on the cervical cancer inquiry 1987-88Ed.
Joanna Manning
Bridget Williams Books with the New Zealand Law Foundation, $39.99, pbk
Reviewed by Elspeth McLean.
Much of what makes it so is the stir created by last year's publication of Auckland University medical historian Prof Linda Bryder's A History of the Unfortunate Experiment at National Women's Hospital.
It would, however, be wrong to delight in this debunking of Bryder's offering, dismiss it as a spat between academics, and ignore the wider issues its 12 contributors - Barbara Brookes, Alastair V.
Campbell, Jacqueline Chin, Sandra Coney, Jan Crosthwaite, Ronald Jones, Joanna Manning, Clare Matheson, Ron Paterson, Charlotte Paul, David Skegg and Voo Teck Chuan - raise and eloquently consider.
As well as giving a concise account of the inquiry and what led to it, the writers' discussions include the importance of thorough historical research, post-inquiry developments (including the code of patients' rights and the role of the health and disability commissioner), ethical behaviour and the inquiry in an international context.
In her book, Prof Bryder claimed the 1988 inquiry by the then Judge Silvia Cartwright got it wrong when it found Assoc Prof Herb Green had been conducting an experiment from 1966 by withholding conventional treatment from women who had carcinoma in situ (CIS) of the cervix.
The judge found that undue suffering was caused to dozens of patients, some of whom later died of cancer.
Prof Bryder implied the inquiry was somehow hijacked by the feminist agenda of Sandra Coney and Phillida Bunkle, whose 1987 Metro magazine article sparked the inquiry.
Prof Bryder contended Prof Green was trying to avoid women having unnecessary surgery and that his views were not out of step with international views at the time on the best way to treat CIS.
Prof Sir David Skegg sets the scene for The Cartwright Papers with an incisive foreword in which he says that "paradoxically, this sorry saga has led to some good outcomes, despite the personal tragedies".
He does not shy away from criticism of Prof Bryder's book, saying she seemed "to have adopted a particular position and then done everything she could to marshall evidence in support of it".
Prof Skegg, a medical epidemiologist, was an expert witness at the inquiry and had described Prof Green's work as the "unfortunate experiment" in a letter in 1984.
The expression became famous after being picked up in the headline of the Coney and Bunkle article.
There is not space here to dwell on the shortcomings of Prof Bryder's book detailed by various writers, including Ms Coney, and University of Otago professors Charlotte Paul (one of the medical advisers to the inquiry) and historian Barbara Brookes.
Prof Paul, who sounds almost incredulous at the book's alleged errors, says if Prof Bryder's distorted "story of blameless doctors, grateful patients and normal scientific conduct is accepted it will set back the profession's difficult task of acknowledging and trying to learn from error".
Obstetrician and gynaecologist Ron Jones, a former colleague of Prof Green and one of the authors of the 1984 research paper on which the Coney and Bunkle article was based, gives a fascinating insight into how difficult it was to have attention focused on the concerns raised.
He describes the events as "the most shameful episode in New Zealand's medical history", reflecting "a basic human frailty, the reluctance of good people to stand up against injustice and powerful individuals".
Several of the authors address the question of whether something akin to the "unfortunate experiment" could occur today, and there are varying answers.
Ms Coney is ambivalent on the question of whether similar unsafe unethical practices would be revealed today, saying the media is less of a public watchdog and government agencies are more impenetrable, but she is also hopeful that a whistleblower in the system might take their concerns to the health and disability commissioner.
The most well known of Prof Green's patients, Clare Matheson, reflecting on her experience, urges people looking at the events now to remember all the women affected.
"Never let us forget that here in this little country there were decades of unethical human experimentation.
"This is our great shame.
"We must never forget, lest it happen again."
• Elspeth McLean is a Dunedin writer and senior health reporter with the Otago Daily Times.
