The Cartwright Collective in association with the Auckland Women's Health Council and Women's Health Action hosted a one-day symposium on cancer screening in New Zealand.
The aim of the symposium was to provide an open forum to:
Bring together health practitioners, health consumers and policy maker
Review the impact of screening in the control of cervical cancer
Review the emerging issues in HPV immunisation in the control of cervical cancer
Explore the implications of moving to HPV testing as the primary screening modality to control cervical cancer
Share knowledge and foster debate
In 1988, the Cartwright Report provided a blueprint for organised cervical screening and paved the way for other cancer screening programmes in New Zealand.
This year our Cartwright seminar looked at the achievements in the control of cervical cancer in New Zealand and explored the implications of options for the future. It included expert speakers from across the screening, research and consumer sectors and panel discussions.
Professor Austin’s presentation on the implications of moving to HPV testing
Biography of Professor Marshall Austin, MD, PhD
University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC
Professor of Pathology and Director of Cytopathology
Dr. Austin has been Professor of Pathology and Director of Cytopathology at Magee-Womens Hospital of University of Pittsburgh Medical Center since 2005. Currently Dr. Austin also assists educator Karyn Varley CT as Medical Director of the Anisa I. Kanbour School of Cytology.
Dr. Austin is a 1977 graduate of the Duke University School of Medicine Medical Scientist Training Program (MD, PhD) with PhD dissertation in virology. He received additional Pathology training at Duke and postgraduate subspecialty training in Gynecologic and Breast Pathology and Cytopathology from 1983-1986 at the Armed Forces Institute of Pathology. Dr. Austin’s current areas of research interest focus on cervical cancer screening, cervical neoplasia risk stratification modeling and risk management, new cervical screening technologies, and public and professional education. He is a past President of the American Society of Cytopathology (ASC) (2004-2005) and 2014 winner of the 2014 ASC Papanicolaou Award.
Presentations from the Cartwright Legacy conference held on Friday 27 September 2013.
Charlotte Paul - "The Saga of cervical Screening in New Zealand: Insights for other screening programmes." The terms 'over-diagnosis' and 'over-treatment' to describe potential harms of screening have recently reached public consciousness. But they are not new. The original Skegg recommendations on cervical screening in 1985 warned that very frequent screening might mean that some women received unnecessary treatment. Moreover, Dr Herbert Green's view that there was no benefit of screening, but only these potential harms, was influential in New Zealand from the 1960s to the 1980s.
Cancer screening initiatives have always had to steer a difficult course as they attempt to maximise benefit and minimise harm to the public. How New Zealand has managed this for cervical screening and the implications for other screening programmes is the subject of this presentation.
Jo Fitzpatrick - "In the valley of the missing link: The Consumer Experience." Where do consumers find themselves 25 years after Cartwright? For the people of New Zealand, and most starkly for the women of Cartwright Inquiry and their whanau, the sobering 'take home' lesson from the Cartwright Inquiry was that a 'Trust Me' message from medicine was no better than one from a used car salesman. Relying unquestionably on either had the ability to main and sometimes kill. This realisation shook us to our foundations. the earth moved uneasily under one of life's accepted certainties.
The Cartwright Inquiry established informed consent as a basic foundation for health service delivery. Coupled with today's emphasis on patient centred care, patient portals, patient journeys and patient directed care pathways, is it unreasonable to expect that the power in medicine has shifted towards consumers as partners in care? So, have we moved from a culture of 'Trust Me' to 'Trust You and Me Together' in the last 25 years? As an active consumer advocate, Jo Fitzpatrick looks at current consumer trends in health and take time to think from the valley of the missing link.
Martin Tolich - "What legacies do the Cartwright recommendations have for ethics committees?" This presentation considers unforeseen legacies of the 1988 Cartwright Commission's recommendations for ethics review in New Zealand. The first legacy is neglect; the manner by which the Health and Disability Ethics Committees (HDECs) have been insufficiently resourced during the past 25 years to promote independent ethics review. To combat this neglect, resilient committee members have demonstrated a willingness to generate innovative solutions in order to sustain and maintain their independence. This sociological analysis examines the juxtaposition of administrative neglect, and a culture of innovation in the current post-2012 HDEC system by focusing on how social groups like HDECs creatively adapt to challenges within their existing order, through a process of conformity, innovation or rebellion. The institutional neglect was manifest when, on average, one in five (18.7%) of the online applications failed to provide independent peer review, thus forcing the HDECs to either ignore this oversight (ie they conform), or create a series of innovative solutions (researcher attendance, review scientific merit. At times HDEC members' adaptations went beyond innovation. Three forms of rebellion were rage, cold calling and Google searching. This paper closes by examining the impact that the new HDEC arrangements have had on universities, and then by making recommendations that would overcome administrative neglect and enhance HDEC independence.
Phillida Bunkle - "The epistemic ethics of how, by, and for whom the legacy of the Cartwright Inquiry is to be established." The Cartwright Inquiry initiated comprehensive reform of treatment and research ethics. However the ethics of how knowledge is made have received far less attention. While some disciplines, including medicine, have begun to address some of these issues, such as publication bias or selective reporting of trial results, recent application of the business model to the academy has left many urgent issues in epistemic ethics unaddressed. This paper considers the example the failure of attempts to correct factual errors in a recent revisionist history about the legacy of the Cartwright Inquiry to raise issues about the place of research subjects in ethical deliberations, and the responsibility of universities and publishers in ethical decision-making, especially in relation to error in academic publications. It concludes that the reform of epistemic ethics remains the unfinished business of the Cartwright legacy which will ultimately determine who, by, and how its legacy will be determined.
Lester Levy - "Building a culture of transparency."
In healthcare systems enhanced transparency can lead to improvements in accountability, choice, productivity, quality, outcomes and social innovation. This presentation focuses on the potential in healthcare systems for heightened accountability and superior quality and outcomes through a new paradigm transparency. Consideration is given to the risks associated with transparency and concludes by making the case that data transparency can have a transformational effect on the improvement of health care system performance.
Marie Bismark - "Learning from patients' voices: the role of complaints in improving the quality and safety of healthcare for women."
The establishment of an independent Health Commissioner, external to the medical professions, was a central recommendation of the Cartwright Report. Drawing on a decade of research with health commissioners in New Zealand and Australia, this presentation discusses the role of external complaints in identifying risks to patient safety. The presentation focuses on three areas of particular relevance to women's health: complaints regarding breaches of sexual boundaries, informed consent to cosmetic procedures, and the identification of practitioners at high-risk of multiple complaints.
“The Cartwright Legacy at 25 Years”
Friday 27 September 2013
10.00 am – 4.30 pm
Fickling Centre, 546 Mt Albert Road, Three Kings, Auckland
An event that marked the anniversary of the Cartwright Report of August 1988*
The programme featured Dame Silvia Cartwright and other speakers:
Dame Silvia - An expose of the role and experiences of victims in the Khmer Rouge Tribunal trials
Professor Charlotte Paul – The saga of cervical screening in New Zealand: insights for other screening programmes
Associate Professor Martin Tolich – How are health and disability ethics committees responding to the prohibition on reviewing the scientrific validity of research?
Phillida Bunkle - The Unfortunate Legacy of the Unfortunate Experiment
Dr Lester Levy – Building a culture of transparency
Marie Bismark - Learning from patients' voices: the role of complaints in improving the quality and safety of healthcare for women
Jo Fitzpatrick - In the valley of the mising link: The Consumer Experience
Cost: $80 (including morning and afternoon tea and paper bag lunch) For further information contact:
Lynda Williams at firstname.lastname@example.org
For further information about the Cartwright Report see:
Organised by the Cartwright Collective:
Ruth Bonita, Phillida Bunkle, Sandra Coney, Jo Fitzpatrick, Jo Manning, Clare Matheson, Betsy Marshall. Julie Radford-Poupard, and Lynda Williams
Sponsored by the Auckland Women’s Health Council and the Cancer Society Auckland
*The Cartwright Report
In June 1987 Phillida Bunkle and Sandra Coney published an article in Metro magazine alleging unethical research at Auckland University’s Post-Graduate School of Obstetrics and Gynaecology at National Women’s Hospital. In response, the Government established a judicial inquiry headed by [then] District Court Judge Silvia Cartwright.
Judge Cartwright’s findings and recommendations were published on 5 August 1988 in what has become known as the Cartwright Report. In addition to finding that the allegations of unethical research were largely correct, Judge Cartwright’s recommendations led to the establishment of the Office of Health and Disability Commissioner and a Code of Health Consumers' Rights. Also, teaching practice was changed at National Women's Hospital and Auckland Medical School to conform to international practice, independent health ethics committees were set up throughout New Zealand, and the National Cervical Screening Programme was established.
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