Hard News: A Real Alternative
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But it does seem likely to me that patient practices were considerably improved in the wake of the Cartwright report
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Yes, like no more routine vaginal swabs of babies, or anaesthetised women being used as training dummies for IUD insertion.
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It seems pretty clear what happened, it’s just that – like the MSM – we prefer to see things in black and white.
The feminists got into government and set about remedying centuries of appalling behaviour towards women (in particular) by the medical profession. Hilary is right in that the details of the particular 'test case' (there was no ‘experiment’, Green’s bedside manner was uncommonly good by the standards of the day, the approach taken wasn’t out of step with the rest of the world etc) are hardly important. There was a greater good at stake, and as Danielle said, the Establishment never rolls over without somebody pushing hard. Harsh for Green and his family, but we’re all benefiting now (even if we could arguably be benefiting even more had it not been for all the misinformation).No surprise then that someone like Kim Hill would be a bit defensive. And no surprise that revisionists on either side of the political spectrum seek to pick open these scabs whenever they occur, while the other side is determined to keep them covered up until society has internalised the issue and moved on.
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Harsh for Green and his family, but we’re all benefiting now (even if we could arguably be benefiting even more had it not been for all the misinformation).
Bloody harsh, it would seem.
Christine O'Brien at AUP has been in touch to say that Bryder's book is out of embargo today and she's sending me a copy.
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Harsh for Green and his family
Understatement. Of. The. Year. My Gran was, to put it mildly, way outside Metro's target demographic but she went out and brought 'The Unfortunate Experiment' issue and followed the Cartwright Inquiry closely. I think it would be a fair precis to say that her opinion of Herb Green was that the only argument against shooting him was that it would be a waste of a good bullet.
And this is a woman, folks, who wasn't prone to joining every passing lynch mob or assuming the worse of people. Not surprisingly, she was a woman who had an intense negative reaction to a phrase like "unfortunate experiment" being applied to a doctor.
But tough shit, right? Might be worth asking the question whether the ends justify the means, and whether its particularly desirable to treat someone's good name and professional reputation as acceptable collateral damage in the pursuit of those ends.
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http://en.wikipedia.org/wiki/Cartwright_Inquiry
Wikipedia article. Is it accurate?
I had a hysterectomy over 20 years ago and was given a fact sheet from National Women's Hospital. It was written by Bonham or Green and was very patronising - they were taking away the cot but not the playpen etc.
To me there is a far wider issue here than the two groups.
I also objected to the tone and one-sided nature of the Listener piece.
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That Wikipedia article seems pretty factual and non-controversial. The piece referenced from the NZ Medical Journal (NZMA) shows controversy has never gone away over the issue. There have been several articles in the NZ MJ over the years confirming the findings and they have passed rigorous peer review.
The Women's Health Action site has lots of reports and articles from the last 20 years.
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Hilary is right in that the details of the particular 'test case' (there was no ‘experiment’, Green’s bedside manner was uncommonly good by the standards of the day, the approach taken wasn’t out of step with the rest of the world etc) are hardly important.
No no no. The details are always important. If you give that up you aren't any better than a nutter ranting about irreducible complexity in a backwoods Arkansas town.
(And if you're a historian who gives that up then!)
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What St ephen said about the politics.
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Who exactly said that Green's bedside manner was uncommonly good? How many women he treated said that, was the data anonymised, and what was the statistical validity?
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My mother had Herb Green as her doctor at National Womens and was always very positive about him. Mum was a nurse, and has always held him in high regard. She thought he was unfairly treated.
She's been pleased to see the Listener article.But this is obviously anecdotal evidence.
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JLM,
If any sees or hears Sandra Coney replying to these new accusations please can you let us know.
I'll be more interested in hearing from Charlotte Paul, an Otago epidemiologist who has written and taught a great deal on the subject. Hers is an opinion I've learned to always respect.
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Professor Charlotte Paul retired recently.
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Who exactly said that Green's bedside manner was uncommonly good? How many women he treated said that, was the data anonymised, and what was the statistical validity?
Yeah OK. It was mentioned by Bryder in the Kim Hill interview, but I don't think you'll find the data you're looking for in her book. I'm sure he could be as patronising as any man of his generation, and apparently a proportion of his patients didn't have a problem with this and were happy to come forward in support.
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To be fair this reveiw has only just been announced. We can't automatically assume "review" means "reduce".
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Charlotte Paul wrote an editorial for the NZ Medical Journal 26 November 2004 on the state of cervical screening in NZ and its history including Dr Green's role, and the same issue also included an assessment by two clinicians, Jones and Fitzgerald on NZ's 50 year history of cervical cytology.
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I'm a little late to this, and possibly a little too young to get into the nuance. However, reading this, I'm wondering how much of it revolves around the idea of 'experiment'. From looking at one of the latest papers from Charlotte Paul:
"The clinical study was not a randomised clinical trial, not all women with CIS were under Green’s care, and no records exist of which women were chosen for that study" (__Lancet Oncology__ , 2008)
This to me implies that there was either no control group, or the identity of the control group were not recorded. Experiment in a scientific sense usually refers to random assignment to groups (*not necessarily but often including a control). Thus, it's probably better characterised as an observational study. Published research on it thus relies on looking at women from that time period at National Women's, who may or may not have had Green, and categorising them based on whether they received 'adequate' treatment. For those purposes of the recent analysis, that means adequate (n=299), probably adequate (n=294), probably inadequate (n=196) and inadequate (n=274). -
an assessment by two clinicians, Jones and Fitzgerald on NZ's 50 year history of cervical cytology
That is particularly interesting.
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Lancet Oncology, 2008
And so is that! I'm wondering about the idea of 'experiment' in this instance too, James. It seems that Green had particular theories about screening and treatment, which he was following whether anyone else agreed or not.
I am itching to get my hands on that Bryder book now.
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Charlotte Paul, in the article Hilary mentions above, notes the contribution of one of Green's contemporaries, discussing what clinicians of that era knew about science. It talks both of a relatively poor grasp of science, the isolated status of clinicians, and an exhortation by their lead educator (Hercus) to do research.
It was, however, I think, as you deduce, the idea that he had a particularly idea, and that he chose to collect data in support of that idea, which would make it unfortunate research. -
I've been reading too, taken on board a few things colouring the shades of grey in my thinking on the subject of the 'unfortunate experiment'. Professor Charlotte Paul's 2004 editorial includes a put down of the substantial article by (Emeritus) Professor Barbara Heslop a few months before as "theoretical". But I found compellling Heslop's perspective on the medical science practices of the post-WW2 era transitional to the modern funding and control of medical research - that there was minimal grasp of hypothesis testing and research design.
It looks very strongly so that (though the word "experiment" may have been used) what was happening was clinical practice and variations thereof, loosely monitored in all senses of the word. So an unfortunate experiment? Perhaps in some senses, but not those with the normally presumed connotations.
The brief exchange in the NZ Medical Journal following Heslop's article (the one link-referenced in the Wikipedia article) is notable for the spokesperson for the Auckland Womens' Health Council ticking all the boxes for a Godwin. And Tony Baird (familiar name) also deplored that attempt to shut down discussion, pointing out the baseless exaggeration of the number of deaths from cervical cancer at National Womens.
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Just started listening to a bit of Bryder's interview now.
I think there are a couple of issues there for me.
*Bryder specifically mentions the impact of child-bearing on treatment decisions (particularly emphasising that patient 'Ruth' went on to have 4 children). Thus, if one were to explore the impact of non-invasive treatment, you would expect a lower rate of invasive treatment in younger women. However, the proportion of inadequately treated women does not vary with age.*Bryder also talks of the lack of consensus about treatment. However, Green was wearing a lot of criticism for his views and running against NZ consensus by 1970 (various quotes in Jones & Fitzgerald). Importantly, according to that article, his practice was running counter to others in the same hospital. It's an interesting question in medicine as to what point do doctors get that their pet theory is wrong in the face of changing evidence (see also: John Money). However, Bryder argues that there was still debate elsewhere (esp. in UK)
*Bryder is also big on the "there were no groups". However, there were, because his colleagues in the same hospital were doing something different. He was experimenting, in the 'experimenting with drugs' sense, where there is no control condition.
@ChrisW -- I'm not sure "theoretical" was a put-down. Heslop's article had 1 reference compared to 50 in the other paper. Heslop was also advancing her own theory grounded in her own experience, as opposed to using quotes from people involved in the debate.
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Finally, on experimentation, it would have been interesting to hear Bryder address this:
"In 1971, Dr Stephen Williams, Pathologist-in-Charge at National Women's Hospital, wrote to Dr George
Wied in Chicago, USA
‘It is unfortunate that our colleague (Green) should have developed an almost obsessional view about the natural history of carcinoma in situ of the cervix, and there is no doubt that his emphatically expressed attitude, coming, as it does from an influential department, has brought confusion to the local scene. I believe that he is sincere, although perhaps bigoted, on this subject. He [Green] bases his conclusions on the statistical interpretations and extrapolations of a smallish series of cases, the composition of which has been questioned. It appears that in a number of cases where invasion has clearly followed the original in situ diagnosis, he has reviewed the histology himself (although he is not a trained histopathologist) and has removed them from his series on the grounds that they were invasive carcinomas from the outset.'In summary, I accuse
Professor Green
in the 1971
with teh statistics
of cooking teh data.
That doesn't sound like an experiment to me. Oh wait... -
Oh, in case my Cluedo reference isn't clear, by "I", I mean Dr Williams, and the those accusations seem like a prima facie case of experimentation.
In unrelated news, my dictionary confirms my belief that Bryder is pronouncing 'in situ' rong.
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Thanks James. I had to read you a couple of times there, but that was interesting ...
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So I've just finished the interview. I think the extent to which Bryder is right or wrong ultimately depends on the view of what the medical consensus was at the time. It seems Bryder is arguing that even at the time of the Cartwright enquiry that while there was a more established consensus in New Zealand, there was more debate internationally, which means that being judged by the international standards of the time, what he was doing was yet to be proved wrong.
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