Tuesday, November 7, 2017

How New Zealand learned from a medical disaster and kept research subjects safe for three decades

New Zealand had its Tuskegee moment in June 1987, when Metro magazine published the investigative report “An Unfortunate Experiment at National Women’s.” According to the report, women with cervical cancer in situ had been deceived and mistreated for years at a prestigious Auckland hospital. Unlike the United States, however, which took 25 years to apologize to the Tuskegee victims and over nine years to establish a flawed, porous system of research oversight, New Zealand responded to the "unfortunate experiment" immediately. The government began a judicial inquiry, held six months of public hearings, and when it was over, instituted far-reaching reforms that have effectively prevented any further abuses for thirty years.

I have written about the "unfortunate experiment" in an essay for the Boston Review based on whistleblower Dr. Ron Jones' excellent account of the story, Doctors in Denial: The Forgotten Women in the Unfortunate Experiment.  Here's a sample from the essay. (You can read the full essay here.)

Academic physicians are not known for their modesty, but even among his peers George Herbert “Herb” Green stood out. Colleagues described him as belligerent and autocratic. “Quite a bully,” says a former laboratory technician at National Women’s Hospital. Conservative in his politics and chauvinistic in his attitudes, Green was an obstetrician-gynecologist who not only opposed abortion but also sterilization. When screening for cervical cancer became widespread, he opposed that too. Green took pride in being seen as a contrarian—a “doubting Thomas,” as he put it. His ability to intimidate others came partly from his size and bearing; Green was a large, gruff man who had grown up in gumboots on a south Otago farm. But his physical size was exceeded by his high self-regard. Green was supremely confident in his own judgment and he was not shy about letting others know it. If egos were cars, Green would have driven a Cadillac Eldorado.

In the end, he drove it over a cliff. In New Zealand Green is infamous as the physician behind the “unfortunate experiment.” His tragic flaw was signaled by a phrase written on his office chalkboard: “Don’t confuse me with the facts—my mind is made up.” Green was convinced that cervical carcinoma in situ (CIS)—a condition in which abnormal cells are found on the surface of the cervix but not yet any deeper—would not progress to invasive cervical cancer. Never mind the scientific evidence, or expert consensus, or even the policy at his hospital, all of which instructed that CIS should be treated, not simply left alone. Green’s confidence in his own judgment was unshakeable. In 1966, with the approval of his hospital superiors and all but one of his colleagues, Green set out to prove his theory to the world, allowing his patients with CIS to go untreated for years without their knowledge or consent. It would be nearly two decades before the deadly results were exposed.

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