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A History of the 'Unfortunate Experiment' at National Women's Hospital
In this carefully researched book, medical historian Dr Linda Bryder provides a detailed analysis of the treatment of carcinoma in situ at National Women's since the 1950s, an assessment of international medical practice and a history of the women's health movement.
250 pages, Paperback
First published July 16, 2010
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November 15, 2023
Green’s decisions had not been dependent on fear of legal proceedings, but on what he believed to be best practice. Nor was there any evidence that he was motivated by the desire to study the natural history of the disease or to retain women’s fertility at all costs, as suggested by some commentators.
I am pro-revisionist histories. The mainstream interpretation of historical events should always be open to be challenge. The initial revisionism should be done sooner rather than later, so that you can ask as many of those involved whether they agree or dissent from the received wisdom.
So, you should probably actually ask them.
Trust me, I’m a doctor
As I understand Bryder’s main assertions:
- The Cartwright Inquiry misrepresented the facts as to whether there a consensus view on whether carcinoma in situ as detected by an abnormal smear result should be treated by partial/full removal of the cervix.
- Doctor Herbert Green took a conservative ‘wait and see’ approach with patients to avoid overtreatment but he was not experimenting (e.g., setting up control groups and comparing results).
As to the correctness of those key points… …uhhhhh all I can really say is Bryder’s views remain dissenting ones from the mainstream. It is a subject that requires a lot of wider reading of the literature. Bryder cites widely, but there are plenty of counter citations available. In one case Bryder seeks to boost someone with an opposing view:
A colleague described Skrabanek’s ‘formidable intellect’ and how he had a wide circle of friends all over the world, partly as a result of his habit of writing to those whose work he admired.
…but the citation links to Skrabanek’s obituary, which is eyebrow raising, as I cannot imagine many obituaries saying the deceased was of moderate intellect with few friends.
Bryder also engages with feminism:
The medical profession itself was polarised, and two feminists stepped into the breach, picking up and running with one side, although ironically this was not the side usually favoured by feminists, as will be discussed.
…and consumer rights infiltrating into medical care:
Above all, however, the Inquiry was about consumer power.,
As Sandra Coney explicitly wrote that her book on "The Unfortunate Experiment" was from a feminist perspective, it is very reasonable for Bryder to delve into wider social currents. However, those currents are not dealt with well in this book. There’s a snideness and lack of depth in Bryder’s commentary. Bryder is patronising as to what side the “feminists” should take, baffled that these certain feminists favour the more intensive treatment option, as well as insinuating that they ended up being tools of interventionalist doctors.
The wide acceptance of the views and pronouncements of these feminists silenced the medical debates and allowed the views of those doctors who favoured an aggressive interventionist approach to CIS to predominate.
In relation to the conduct at National Women’s Hospital generally, the defences appear to be based around what was allegedly common practice worldwide at the time. Bryder also engages in some hurried passing over of revelations such as vaginal swabs of female babies (Bryder’s position is that this was okay as it was not racially based), or that Herbert Green could be a bit full on in medical debates and maybe a bit gruff. Bryder points out that plenty of patients had nice things to say about him, which presumably counteracts any bad experiences any other patient had.
Again, I cannot say whether Bryder is right or wrong on either any specific points or her central thesis. I lack the qualifications to render any judgement on that. However, while I am fine with Bryder taking shots about the more outlandish claims, such as the number of actual deaths caused by Green’s approach, I still struggle to see that this book was that great a defence of him. It seems to devolve into:
“Doctor knows best, especially this doctor.”
Maybe just pick up the phone
I am poking around the edges of the main issue with this book:
In the early stages of researching the general hospital history, I had contracted Dr Jenny Carlyon to conduct interviews with many of those involved with the hospital. The mass of written material concerning the Cartwright Inquiry made it unnecessary to conduct further or more focused interviews.
At the time of publication a number of participants in “The unfortunate experiment” and the Cartwright Inquiry were still alive. One was Clare Matheson, who’s recollections Bryder is quite critical of on multiple occasions. This seems quite harsh the context of Matheson being a patient of Green rather than a doctor arguing a point:
This patient had clearly viewed him as a father figure. She had now been persuaded otherwise, not by his behaviour but by the Inquiry.
Another example is Bryder’s commentary about how Many Maori women did not appear to subscribe to the dominant feminist political perspective when reviewing the records without following it up with any individual interviews.
It was not difficult for me to read this book and go “Hmmm, wonder what these people might actually say.”
It turns out this is a highly unoriginal thought, because others came to the same conclusion shortly after publication of this book. It also turns out they did think to interview a number of people, including Clare Matheson, along with Professor Skegg (the coiner of “The Unfortunate Experiment”). Bryder came in for a bit of a blast.
I do not believe the lack of interviews dooms a book. But when you are relying on archival material, you do concede the initiative to participants who are still around, particularly when they point out errors that, while potentially minor (such as the number of children Matheson had), imply a sloppiness to the research.
As evidenced in From crime to care, where the author unsuccessfully reached out to Sandra Coney, I accept you shouldn’t suspend all efforts on a book due to the refusal of a participant to engage. However, “The Unfortunate Experiment” was recent enough history for Bryder to have done more – to have at least inoculated itself against those likely to be critical. I wouldn’t mind if Bryder had said Skegg did not know what he was talking about, if she had at least talked to Skegg first (this omission seemed very damning to me).
One possible reason might have been budgetary considerations, which is not raised so I cannot say that is a definite excuse. It is however fair to mention that there probably were likely funding constraints on what would be a niche and technical subject. There is also the argument about people crafting their recollections to best fit acceptable positions today, rather than letting their words at the time speak for themselves. However, I would have still wanted to see a contrast between the two.
These letters reflected the general anti-doctor/anti-expert feeling of the time, but with little knowledge of the facts of the case.
Hmmmm.
You should read this book if you wanted to delve into the history of “The Unfortunate Experiment” because it is the most accessible of the dissenting views. It has its champions (such as The Cochrane Institute).
Yet, I am not impressed it. It is one thing to be patronizing and opinionated, another to be patronizing and opinionated when the subjects are (metaphorically) standing right there in front of you.
I am pro-revisionist histories. The mainstream interpretation of historical events should always be open to be challenge. The initial revisionism should be done sooner rather than later, so that you can ask as many of those involved whether they agree or dissent from the received wisdom.
So, you should probably actually ask them.
Trust me, I’m a doctor
As I understand Bryder’s main assertions:
- The Cartwright Inquiry misrepresented the facts as to whether there a consensus view on whether carcinoma in situ as detected by an abnormal smear result should be treated by partial/full removal of the cervix.
- Doctor Herbert Green took a conservative ‘wait and see’ approach with patients to avoid overtreatment but he was not experimenting (e.g., setting up control groups and comparing results).
As to the correctness of those key points… …uhhhhh all I can really say is Bryder’s views remain dissenting ones from the mainstream. It is a subject that requires a lot of wider reading of the literature. Bryder cites widely, but there are plenty of counter citations available. In one case Bryder seeks to boost someone with an opposing view:
A colleague described Skrabanek’s ‘formidable intellect’ and how he had a wide circle of friends all over the world, partly as a result of his habit of writing to those whose work he admired.
…but the citation links to Skrabanek’s obituary, which is eyebrow raising, as I cannot imagine many obituaries saying the deceased was of moderate intellect with few friends.
Bryder also engages with feminism:
The medical profession itself was polarised, and two feminists stepped into the breach, picking up and running with one side, although ironically this was not the side usually favoured by feminists, as will be discussed.
…and consumer rights infiltrating into medical care:
Above all, however, the Inquiry was about consumer power.,
As Sandra Coney explicitly wrote that her book on "The Unfortunate Experiment" was from a feminist perspective, it is very reasonable for Bryder to delve into wider social currents. However, those currents are not dealt with well in this book. There’s a snideness and lack of depth in Bryder’s commentary. Bryder is patronising as to what side the “feminists” should take, baffled that these certain feminists favour the more intensive treatment option, as well as insinuating that they ended up being tools of interventionalist doctors.
The wide acceptance of the views and pronouncements of these feminists silenced the medical debates and allowed the views of those doctors who favoured an aggressive interventionist approach to CIS to predominate.
In relation to the conduct at National Women’s Hospital generally, the defences appear to be based around what was allegedly common practice worldwide at the time. Bryder also engages in some hurried passing over of revelations such as vaginal swabs of female babies (Bryder’s position is that this was okay as it was not racially based), or that Herbert Green could be a bit full on in medical debates and maybe a bit gruff. Bryder points out that plenty of patients had nice things to say about him, which presumably counteracts any bad experiences any other patient had.
Again, I cannot say whether Bryder is right or wrong on either any specific points or her central thesis. I lack the qualifications to render any judgement on that. However, while I am fine with Bryder taking shots about the more outlandish claims, such as the number of actual deaths caused by Green’s approach, I still struggle to see that this book was that great a defence of him. It seems to devolve into:
“Doctor knows best, especially this doctor.”
Maybe just pick up the phone
I am poking around the edges of the main issue with this book:
In the early stages of researching the general hospital history, I had contracted Dr Jenny Carlyon to conduct interviews with many of those involved with the hospital. The mass of written material concerning the Cartwright Inquiry made it unnecessary to conduct further or more focused interviews.
At the time of publication a number of participants in “The unfortunate experiment” and the Cartwright Inquiry were still alive. One was Clare Matheson, who’s recollections Bryder is quite critical of on multiple occasions. This seems quite harsh the context of Matheson being a patient of Green rather than a doctor arguing a point:
This patient had clearly viewed him as a father figure. She had now been persuaded otherwise, not by his behaviour but by the Inquiry.
Another example is Bryder’s commentary about how Many Maori women did not appear to subscribe to the dominant feminist political perspective when reviewing the records without following it up with any individual interviews.
It was not difficult for me to read this book and go “Hmmm, wonder what these people might actually say.”
It turns out this is a highly unoriginal thought, because others came to the same conclusion shortly after publication of this book. It also turns out they did think to interview a number of people, including Clare Matheson, along with Professor Skegg (the coiner of “The Unfortunate Experiment”). Bryder came in for a bit of a blast.
I do not believe the lack of interviews dooms a book. But when you are relying on archival material, you do concede the initiative to participants who are still around, particularly when they point out errors that, while potentially minor (such as the number of children Matheson had), imply a sloppiness to the research.
As evidenced in From crime to care, where the author unsuccessfully reached out to Sandra Coney, I accept you shouldn’t suspend all efforts on a book due to the refusal of a participant to engage. However, “The Unfortunate Experiment” was recent enough history for Bryder to have done more – to have at least inoculated itself against those likely to be critical. I wouldn’t mind if Bryder had said Skegg did not know what he was talking about, if she had at least talked to Skegg first (this omission seemed very damning to me).
One possible reason might have been budgetary considerations, which is not raised so I cannot say that is a definite excuse. It is however fair to mention that there probably were likely funding constraints on what would be a niche and technical subject. There is also the argument about people crafting their recollections to best fit acceptable positions today, rather than letting their words at the time speak for themselves. However, I would have still wanted to see a contrast between the two.
These letters reflected the general anti-doctor/anti-expert feeling of the time, but with little knowledge of the facts of the case.
Hmmmm.
You should read this book if you wanted to delve into the history of “The Unfortunate Experiment” because it is the most accessible of the dissenting views. It has its champions (such as The Cochrane Institute).
Yet, I am not impressed it. It is one thing to be patronizing and opinionated, another to be patronizing and opinionated when the subjects are (metaphorically) standing right there in front of you.
December 10, 2018
A fascinating but challenging read about medical ethics and politicised feminism in the 1980s. The misunderstanding of medical diagnoses and treatment protocols in favour of challenging medical patriochy and furthering egotistical journalistic careers is astounding. However, the benefits of this enquiry echo today in strengthened medical ethics and informed consent.
September 1, 2021
What a load of trash. Careful research?? - what a joke!!
All I read is a manipulated, narrow minded person with tunnel vision and to whom apparently loyalties were at the time especially...more important than women's health and well-being. The truth of the story was already told and plain to see for any slightly intelligent person.
Don't waste any hours of your life ready this.
All I read is a manipulated, narrow minded person with tunnel vision and to whom apparently loyalties were at the time especially...more important than women's health and well-being. The truth of the story was already told and plain to see for any slightly intelligent person.
Don't waste any hours of your life ready this.
Want to Read
September 7, 2009The most controversial health title for years. Prior to reading, my impression from media interviews is that the writer has "misunderstood the science" - and wrongly judged a New Zealand inquiry into cervical cancer which criticised the way some women were treated (or not treated).
June 9, 2011
Absolutely fascinating! It challenges everything you think you know about this so called 'experiment' and it is very convincing. Surprisingly easy to read and rather un-put-downable as well.
Displaying 1 - 5 of 5 reviews