This edition of the NZMJ contains a number of letters about what became known as the ‘Unfortunate Experiment’. In many ways New Zealand has been fortunate as a result of these events in that they led to a complete revamp of our medical, legal, and ethical environment as outlined by Professor Ron Paterson’s editorial in the same edition.1
Recent books2,3 have not surprisingly generated a lot of conflicting views and heated debate as they have tried to shed new light on the events that occurred. It has been the re-exploration of events by Professor Bryder that led to her book being published,2followed by two book reviews with contrasting views that the NZMJ published.4,5
Then Professor Charlotte Paul contacted me wanting to write an editorial about the book review4 which was supportive of Professor Linda Bryder’s book. Given Professor Paul’s key role on the Cartwright Report and the career that she has since built at least in part on these issues, I suggested that she write either a:
- Letter to the editor which would be more appropriate if she wanted to disagree with a book review that we had published, or
- An article exploring issues around the Cartwright Report that had been raised by Professor Bryder’s book—but this must provide us with new insights into the issues and the article must not focus solely on criticism of the author, Bryder. (There are many other avenues, for example theListener, for publicly disagreeing with a published book.)
The Journal received from Professor Paul a very wordy manuscript which didn’t fulfil the guidelines I had given her. We then spent some months reviewing her article and reflecting on whether it really did contribute anything to the debate. In the end I decided to publish it, but thought that perspectives should also be given by others and so I asked Professor Ron Jones and Professor Linda Bryder to separately write editorials, while pointing out that they would get to see each other’s editorials for comment pre-publication.
Linda Bryder produced an interesting and thoughtful editorial. Professor Jones refused the offer. Then Professor Paul withdrew her manuscript because she did not feel that it was reasonable to have Professor Bryder writing an editorial on this issue.
Amongst much media publicity (including lead items on national media) within a few days of withdrawal of this manuscript Professors Jones and Paul published an article in the Australian and New Zealand Journal of Obstetrics and Gynaecology.6 They reported:
Over the past few months the Journal received the letters on these issues (which are published in this edition) plus I asked for an editorial from Ron Paterson that outlines the medical-legal-ethical significance of the Cartwright Report.
We informed Professor Bryder that Professor Paul had withdrawn her manuscript and asked Professor Bryder to rewrite her editorial removing any reference to what Professor Paul had said in her withdrawn manuscript.
I have decided to publish these editorials and letters in the Journal despite my concern that the real issues are being increasingly lost over time since these events occurred. However the papers provide an interesting perspective and a somewhat insightful perspective.
Over this period I have received numerous emails from many self-interested parties offering advice on how to run the Journal and how I should deal with these issues. Choosing to publish these letters and editorials relates to the need for free discussion of the issues and not personal attacks on those who are the messengers.
With this current background it is important, amongst all this recent dialogue and the effect of various personalities, not to forget the real issues which are:
- Consent for studies at the time when these studies was undertaken were inadequate by today’s standards.
- People were harmed. This is described in the article by Professor Paul and colleagues in article in Lancet Oncology7 in 2008 where the authors state:
- A key unresolved issue to some would appear to be whether the two groups had received the same treatment or not. In the Journal it is argued by some that they did [receive the same treatment] as the division is dependent on treatment outcomes decided only at 2 years.8
The context in which these events occurred is the issue for discussion, not whether they happened. The result, as Professor Paterson states, is that “ most importantly, there has been an attitudinal shift within the medical profession.”1
The New Zealand medical system has gained much from what happened. Some individuals have been blamed for what happened, while it is in reality institutional systems that resulted in the problem, not a “rogue doctor”.
Similar issues are worth exploring to avoid institutional blindness resulting in similar problems harming patients again.