The Cartwright Inquiry & the Controversy

Reprehensible Attempts to Re-write History

Twenty-one years after Judge Silvia Cartwright’s report on the treatment of cervical cancer at National Women’s Hospital was released Linda Bryder published her revisionist version of events leading up to, during and following the 1987-88 Cartwright Inquiry; the book A History of the Unfortunate Experiment at National Women’s Hospital.

Bryder’s book elicited almost as much outrage as the original expose of the unethical research that was carried out on women at National Women’s Hospital in the 1960s and 70s.

At the time, Lynda Williams wrote:

“A careful reading of her book reveals that it is possible to prove almost anything if you quote enough people, and quote them out of context. This applies to both health professionals and consumers – or as Linda Bryder refers to some of us – feminist health activists. In fact, according to Linda Bryder, you can even have a career as a feminist health activist!”

Bryder claimed that Judge Silvia Cartwright got it wrong and that the 1988 Report on the Inquiry into the treatment of cervical cancer at National Women’s Hospital was based on a misunderstanding, and there was no experiment at National Women’s Hospital.

Her book was not the first time that attempts had been made to dispute the findings of the Cartwright Inquiry and to discredit the testimony of many of those who gave evidence at the Inquiry. However, it is important to bear in mind that many who have written about what went on at National Women’s Hospital did so without having seen the medical files of the women who did not receive the treatment they should have and as a result got cervical cancer. Some of these women died.

Although each chapter of her book contains hundreds of references it doesn’t take long to realise that Linda Bryder is misleadingly selective in her approach to the medical literature of the four decades from the 1950s to the 1980s. Some of the professors she quotes would turn in their graves if they could see how badly they have been misrepresented in this book.

Bryder also mispresents the medical history of the woman at the centre of the Cartwright Inquiry, Clare Matheson, despite the fact that Clare Matheson’s medical file can be found in both the Cartwright Report as well as being detailed in the book that Clare wrote about her experience, Fate Cries Enough. Clare’s response to the book can be found in the first link in the righthand column of this page and in an article in the New Zealand Herald for which she was interviewed.

In the book, Bryder claims that the majority of those involved in the unfortunate experiment at National Women’s Hospital in the 1960s and 70s and those who gave evidence and took part in the subsequent inquiry in 1987 and 1988 got it wrong.  That:

• • there was no experiment;
  • there were no groups of untreated and/or inadequately treated women; that
  • no women died as a result of not having adequate treatment for their cervical lesions
  • Judge Cartwright got it wrong;
  • her medical advisors – Linda Holloway, Charlotte Paul and Professor Eric MacKay – got it wrong;
  • the experts from around the world who came to give evidence at the Inquiry, including those who examined around 1200 patient files, got it wrong; and
  • the women themselves got it wrong.

Bryder claimed despite all the evidence to the contrary, that Dr Herbert Green was not withholding conventional treatment from women referred to the hospital with abnormal smears, and he was just doing what many other gynaecologists were doing in the 1960s and 70s.

“Second thoughts” Metro article
In June 1990, Metro published a “second thoughts on the unfortunate experiment at National Women’s” article written by Jan Corbett. Linda Bryder’s book canvasses the same issues that were raised in the second Metro article.

The arguments were based on the assertion that Herbert Green did not divide women who had had abnormal cervical smears into two groups, and treat one group and not treat or inadequately treat the other group.

However, what both Jan Corbett and Linda Bryder chose to ignore is the fact the Herbert Green published a number of papers in medical journals in which he reported on the outcomes of patients that he himself had divided into various groups. The fact that these groups were not exactly the same groups that appeared in the 1984 scientific paper published by Dr Bill McIndoe and his colleagues is totally irrelevant.

As Professor Charlotte Paul said on National Radio on 15 August 2009, and again in her and Professor Linda Holloway’s article in the 12 September 2009 issue of the Listener, “Bryder does not understand the 1984 paper,” she “is confused about the two groups of patients” and she has got it wrong.

Perhaps if Linda Bryder had deigned to interview some of the medical experts involved in the Cartwright Inquiry she might have understood what Herbert Green did and what the medical files of the women who came to National Women’s Hospital in the 1960s and 1970s for treatment revealed about the result of his decade of research and experimentation.

Dismissing the women
One of the most troubling aspects of Bryder’s book is her portrayal of some of the women involved in the ‘unfortunate experiment’ and in the Inquiry. Her total misrepresentation of what happened to Clare Matheson, one of Herbert Green’s patients, is cruel as well as being inaccurate. When challenged by Clare Matheson following the book’s publication, Linda Bryder said she had got the information about Clare Matheson’s medical history from a newspaper article by Jan Corbett! This raises the question of why she would do that. After all Clare’s medical file is documented in detail in both the Cartwright Report and Clare Matheson’s own book Fate Cries Enough, publications that feature many times in the references in Linda Bryder’s own book. A medical historian should surely go back to the primary source to check the accuracy of her information.

Clare Matheson
Bryder omitted the most significant piece of information in Clare Matheson’s medical file – the fact that when Clare was discharged from hospital her file contained a histological report from a recent dilatation and curettage (D&C) she had had, stating that there were “fragments of carcinoma devoid of underlying stroma, probably carcinoma-in-situ.”

Herbert Green was aware of this report. He wrote in her medical file: “the histology report is somewhat surprising,” and yet in the discharge letter to Clare Matheson’s GP he wrote: “she has no more chance than the next person of developing any carcinoma of the cervix.” Clare Matheson was diagnosed with cancer six years later and had to undergo 36 hours of radiotherapy with caesium rods wedged in her vagina, then a Wertheim’s hysterectomy that involved removal of her uterus, ovaries, part of her cervix, and her lymph nodes. Linda Bryder was very dismissive of this during an interview with Kim Hill on Radio New Zealand. After all, she said, Clare Matheson was still alive.

The fact that Clare’s cancer could have been prevented if she had been adequately treated when she first went to the hospital, and that Clare was placed by Herbert Green in one of his “conservatively treat” groups is not acknowledged by Bryder. Neither is the fact that the women in this group were subjected to multiple biopsies to check for invasive cancer. Some women had up to six biopsies, which meant repeated general anaesthetics, painful side effects and terrible scarring of the cervix making the reading of further cervical smears unreliable. It is, therefore, an absolute fallacy to argue that Herbert Green’s intention was to protect patients from unnecessary surgery. His refusal to adequately treat and totally remove diseased tissue often resulted in even more radical surgery and put the women’s lives at risk.

Judge Silvia Cartwright
Bryder’s depiction of Silvia Cartwright is also unbelievably patronising and insulting. In both her book, and during the interview she did with Kim Hill on National Radio, she describes the Judge as someone who was unfamiliar with medical matters, who was easily led by the feminists health activists who wrote the original Metro article. Bryder said Judge Cartwright’s  sympathy for the women who had had cancer and who appeared before her resulted in her judgment being emotionally distorted.

In the final chapters of her book Bryder focuses her attack on Professor Charlotte Paul whom she describes as having discussions about the unfortunate experiment and the Inquiry with overseas experts such as Malcolm Coppleson, Paul Gerber and others, thus turning them against Herbert Green.

Fortunately, the evidence given at the Cartwright Inquiry is still highly accessible. Subsequent articles and papers will reveal just how confused Linda Bryder is about the 1984 McIndoe paper, the groupings of women with abnormal smears, Green’s refusal to adequately treat and completely remove diseased tissue, and just what happened to many of these women.