Reviewed by Sue Bond 

In 1987 I spent a month in Auckland as a student at the North Shore hospital. A journalist friend drew my attention to an article in Metro magazine of earlier that year that had revealed a scandalous experiment at the National Women’s Hospital, concerning women with cervical cancer. So when I saw Linda Bryder’s A History of the ‘Unfortunate Experiment’ at National Women’s Hospital, I was curious to remind myself of this scandal, and perhaps learn the whole story.

Two women, journalist and feminist activist Sandra Coney and sociologist Phillida Bunkle, wrote the 1987 article called ‘An Unfortunate Experiment at National Women’s’ that alleged Dr Herbert Green, an obstetrician and gynaecologist, had withheld conventional treatment from women with abnormal cells in their cervix (carcinoma in situ or cervical dysplasia) to study the course of the disease. A proportion of these women went on to develop cervical cancer, and some of those died. As a result of this article, the Labour Government of the time set up an Inquiry, lead by Judge Silvia Cartwright, which produced a report in July 1988 that concluded the medical profession had failed patients. Many recommendations of Cartwright were implemented, including national screening and patient advocacy.

Linda Bryder is a medical historian, and was researching the history of the National Women’s Hospital (NWH) when she realised that the cervical ‘experiment’ needed a book of its own. What she has produced is methodical, detailed, thoroughly researched and scholarly, if a little dry at times. It is probably more for academics and medical professionals than the general reader, though the lessons she draws from her research are important for society as a whole. As she states in her introductory chapter, the ‘examination of the Cartwright Inquiry provides a lens through which to explore the relationship between women’s bodies, technology and medicine in the late twentieth century’ (6). I think it also reveals the disjunct between the medical community and the public when it comes to understanding health and disease, and that the media often fails to be the bridge between the two.

Bryder explains that, at the time of Green (and for many years afterwards) carcinoma in situ (CIS) was not completely understood with respect to whether or not it was always a precursor to invasive cancer. At the time of Green’s ‘experiment’, beginning in the 1960s, debates raged all over the world as to its significance. The crux of the matter was how to treat it: should there be an interventionist approach, or a more conservative one? The Pap smear was being used from the 1950s, but the ‘medical significance of lesions discovered … was far from clear’ (15). As the author notes, the Cartwright Inquiry ‘inadvertently revealed a profession divided’ (74), as there really was no consensus about these issues.

What Green did that became so controversial was to submit a proposal to NWH that CIS be treated more conservatively, to attempt ‘to prove that carcinoma-in-situ is not a pre-malignant disease’ (24). What he actually stated (but it wasn’t recorded in the minutes of the proposal meeting with the hospital board) was that CIS is not invariably a pre-malignant disease, that one important word making a lot of difference. The proposal was accepted and from 1966 onwards, Green adopted his management protocol (not an ‘experiment’). He believed in careful diagnosis and follow-up, and balancing the risks and benefits of treatment; any ‘research’ always came second. It seems clear that he did the best he could clinically for his patients, and did, in fact, treat those women whose condition became invasive. What he did not do was treat CIS with radical surgery, which some of his colleagues found disturbing.

Coney and Bunkle based their article on a 1984 paper detailing a study by colleagues of Green’s at NWH. The long-term follow-up study was led by cytologist William McIndoe, and involved using Green’s patients to examine the invasive potential of CIS. Bryder notes that Coney, Bunkle and Cartwright missed the point that Green did not divide his patients into groups, treating one and not the other; McIndoe and his co-writers did this retrospectively for the purposes of their paper. This mistake was admitted by the three women, but the idea persisted. The two ‘groups’ consisted of a) women whose cytology returned to normal after two years, and b) women who continued to have positive Pap smears. McIndoe concluded that CIS had significant invasive potential.

The issue of dividing the women into groups seems to have been just one of several examples of misinformation taking on a life of its own. There was also confusion about the difference between carcinoma in situ and actual cervical cancer, as not only the media but also those involved in the Inquiry used the terms interchangeably at times (66). Bryder points out that Coney and others seemed to think that intervention after a positive Pap smear would automatically be curative, when that is not always the case: disease and its treatment is often more complex. Politics and personality clashes inevitably came into the story, as did the persistent issue of failure of adequate communication between doctors and patients, as well as communication about health and illness issues generally. This book is invaluable for discussing this issue alone.

I developed the feeling whilst reading this history that Herb Green was a competent, thinking gynaecologist who genuinely wanted to reduce the suffering of his female patients, and limit unnecessary surgical and other intervention. Although she spends much time defending Green, I feel this is justified from the evidence of her research: he was not conducting ‘Auschwitz’-like experiments, as some described them, but trying to work out the best way to treat his patients.

But he also was probably paternalistic and old-fashioned in the ‘that’s a good girl’ sort of way. The author describes in some detail the politics of women’s health at the time, and notes that although Green was anti-abortion, he supported women being in control of their reproductive health, and was sensitive to women’s perspective on hysterectomy (121).

Bryder does point out the irony that Coney and Buckle were actually advocating increased intervention, which would have sometimes meant more hysterectomies, when feminists generally were concerned at the over-medicalisation of women’s health in many areas. Indeed, Coney herself has published material (e.g. The Menopause Industry) on this issue.

I think that Bryder has shown the negative and positive aspects of both sides of the argument, and highlighted the need for communication between all parties. Coney and Bunkle and the Cartwright Inquiry produced a heightened awareness of women’s health (and health generally), but also showed an incomplete understanding of the complexities of illness and its management. The media seemed to grasp hold of simplified, sometimes distorted versions of the story, and this confused the issues for the public, instead of clarifying them.

Since the publication of Bryder’s book, there has been a vigorous negative response from those who were involved in the Inquiry, and subsequent implementation of its recommendations. I think Linda Bryder’s book is a valuable contribution to medical history, feminism and the politics of health care, and continues the much needed scholarship and debate about the practise of medicine, and its communication to the public.

A History of the 'Unfortunate Experiment' at National Women's Hospital

(2009)

by Linda Bryder 

Auckland University Press

ISBN 9781869404352.

264pp; NZ $45.