Major Opposition to the Cartwright Inquiry:
The Cartwright Inquiry is inherently feminist and it raised serious questions about the power relationship between the doctor who “knows best”, and the “irrational” female patient. In the inquiry, feminists pushed for the empowerment of women to be active partners in their health care, and for women’s bodily processes to become medicalized [1]. In 2009, Linda Bryder published a book titled “A History of the ‘Unfortunate Experiment’ at National Women’s Hospital.” This publication is among the few that challenge the ideas of the Cartwright Inquiry. Bryder claims that there was no experiment, and she believes that Green was just a conservative physician following the medical trends of the time. Bryder’s anti-feminist rhetoric distracts her from the fact that Green abused his powers as a physician; Green is not a victim of a feminist attack because his crimes have been proven.
Conservative Treatment:
In a follow up essay written in 2011 titled “Unfortunate Experiment or Medical Uncertainties?” Bryder restates her idea that Green’s motives for withholding treatment to some of his patients was popular thought that many pre-remptive treatments are too aggressive and high risk. Green questioned the necessity of an aggressive treatment such as hysterectomy or cone biopsy in treating patients with carcinoma in situ (CIS) because not all patients with CIS developed cervical cancer [2]. Bryder argues that Green was amongst physicians of the time that advocated “conservative” treatments and rejected giving cone biopsies and hysterectomies to women who had CIS on the basis that the treatment is too aggressive.
Bryder references Australian gynaecologist, Malcolm Coppleson, in a statement where Coppleson reflects on the legacy of large numbers of hysterectomies and biopsies conducted based on loose interpretations of abnormal pap smears [3]. Coppleson states that many gynecologists have only recently started to question aggressive treatment of CIS and Bryder lays claim that Green was “far from alone in questioning a radical or aggressive approach to the condition” and that he was ahead of his time [4].
Discrepancies of Grouping in the Experiment:
Bryder continues that the Cartwright Inquiry misinterprets data found in the 1984 study conducted by Bill McIndoe and Jock McLean, because the 1984 study reports that Green did not have two groups of patients labeled as treated and untreated. Bryder argues that there was no experiment because of the way in which patients were grouped. Green’s patients were divided into the two groups according to the positive or negative pap smear results recorded two years following initial diagnosis [5]. Furthermore, majority of patients in both groups received hysterectomies or cone biopsies. Those who had successful initial treatments were placed in the first group and those that did not have successful initial treatments were placed in the second group labelled “continuing to produced abnormal cytology”[6]. Bryder argues that despite what the Cartwright Inquiry states, there were no two distinctive groups of treated and untreated patients. The patients were placed in the two groups according to outcomes of initial treatment, not by the type of treatment given to them, and therefore a higher percentage of patients from group 2 developed cancer since those patients continued to produce abnormal cytology. However, Bryder fails to mention that most of the patients entered into group 2 were given partial or incomplete initial biopsies so that Green could preserve the CIS [7]. The women with partial CIS were then observed for cancerous developments without given treatment for the CIS. Green was, indeed, deliberately placing some patients at substantial risk of developing cervical cancer. Ann Else states that “Green’s study provided conclusive proof that his theory was completely wrong” within the first few years of the experiment, but Green and National Women’s Hospital failed to act accordingly and stop the experiment [8]. There is definitive proof that Green neglected the patient rights of hundreds of women in his experiment and was well aware of the results but continued putting the lives of women at risk.
Disqualifying Bryder:
Bryder’s work seems convincing if it is one’s first source, but she misinterprets the experiment wholly and countless scholars have discredited her work. Barbara Brookes outlines Bryder’s thesis as “Green and National Women’s became scapegoats in a drama precipitated by an assertive feminist movement intent on destroying the power of the medical establishment” [9]. She explains how Bryder had to vindicate Green in her book to support her thesis, and exposes Bryder’s thesis-driven and misconstrued research. Anna Else emphasizes that Bryder makes almost no reference to the evidence in the Cartwright Inquiry and also selectively chose not to interview any of the survivors of the experiment for her book [10].
Prevalence of the One-Dimensional View of Medical History:
Despite being wholly discredited, one recurring theme that Bryder addresses effectively is the one-dimensional, black-and-white view of medical history that has existed, and still exists today. Bryder stresses the fact that medical history has to account for the constant changes in medical practice, and laments that “doctors are more likely to be criticized for under-treatment than over-treatment, even if the latter does more harm than good”[11]. Dr. Green’s actions cannot be justified, but Bryder brings up a good point that too often a medical practitioner is labelled as good or bad, when in reality, acceptable medical practices are changing all the time, and the same medical practitioners can be regarded as good or bad at different points in time. It is important to understand and account for all of the beliefs, technologies, and advancements of the time when examining medical controversies.
References:
[1] “Cartwright Inquiry,” Women’s Health Action. accessed October 9, 2016, http://www.womens-health.org.nz/consumer-rights/cartwright-inquiry/.
[2] Linda Bryder, “Unfortunate Experiment or Medical Uncertainties?” Auckland Medico-Legal Journal (2011): 2.
[3] Linda Bryder, “Unfortunate,” 9.
[4] Linda Bryder, “Unfortunate,” 9.
[5] Linda Bryder, “Unfortunate,” 3.
[6] Linda Bryder, “Unfortunate,” 4.
[7] Ann Else, “The ‘unfortunate experiment’ and the Cartwright Inquiry, twenty years on: why getting it right matters,” Women’s Studies Journal 24, 2 (2010): 4.
[8] Ann Else, “The ‘unfortunate experiment’,” 4.
[9] Barbara Brookes, “The Making of a Controversy,” The Cartwright Papers: Essays on the Cervical Cancer Inquiry, 1987-88, eds. Joanna Manning (Bridget Williams Books, 2009), 104.
[10] Ann Else, “The ‘unfortunate experiment’,” 3.
[11] Linda Bryder, “Unfortunate,” 16.
The Cartwright Inquiry 