A history of the ‘unfortunate experiment’ at National Women’s Hospital. Linda Bryder. Auckland: Auckland University Press, 2009 (vi + 250 pp). ISBN 978 1 86940 435 2.

The so-called “unfortunate experiment” of this book triggered the 1987 New Zealand Cartwright Inquiry into cervical cancer treatment. Consultant gynaecologist Herbert Green of the Auckland National Women’s Hospital was the main target of a long and complex legal process hinging on allegations that he had prospectively studied two groups of women referred to the hospital with positive cervical cytology. One large group received treatment, following which most had no further problems (although some later developed invasive cancer). The second group, it was said, had no treatment but, despite positive cytology, were followed for years so that the natural history of what are now called high-grade epithelial abnormalities (formerly carcinoma-in-situ) could be studied; these women were 25 times more likely than the first group to develop invasive cancer, from which some of them died. Green was accused of callously disregarding the health of these women to satisfy his own scientific curiosity, and condemnation of his actions was central to the findings of the inquiry.

However, as Linda Bryder painstakingly demonstrates, there was no such “experiment”. The two groups were a statistical construction in a 1984 paper by four of Green’s colleagues.1 Both groups had been treated but when positive cytology persisted, women were (unsurprisingly) more likely to develop invasive cancer. Green himself certainly advocated a less interventionist approach to the management of cervical pre-malignancy, which in the 1960s tended toward hysterectomy and in the 1970s to cone biopsy. A more low-key approach, now that we understand the role of human papillomavirus and have LLETZ (large loop excision of the transformation zone) procedures available, is universally practised — but, as I’ve observed over my own 30 years of gynaecological practice, it has required a great deal of clinical and scientific effort, much of it by people like Green, to reach this point.

Bryder’s book is meticulously referenced and even-handed — although she does not conceal criticism of the feminist health activists who instigated the inquiry. Undoubtedly, the book will arouse much comment from those still able to recall these events, but as a work of medical history it will be a valuable and lasting resource.