Linda Bryer. Published by Auckland University Press, August 2009. ISBN 978186940435. Contains 264 pages. Price $45
This account by an Auckland historian of the events leading to the Cervical Cancer Inquiry in 1987 is based on the premise that the ‘unfortunate experiment’ did not occur.
Perhaps it is unreasonable to expect a historian to give much thought to the pathology that underpins clinical practice. But Dr Bryder seems not to have realised that Herb Green’s approach to management stemmed from an idiosyncratic view of cervical pathology. He had noted that adult carcinoma in situ looked very similar under the microscope to a lesion found quite commonly in the foetal cervix. Because young girls do not get cervical cancer, Green deduced that the foetal lesion was innocuous. Therefore, he surmised, adult carcinoma in situ might also be harmless.
He proceeded to test this hypothesis.
While the textbooks of his day classed cervical dysplasia (with carcinoma in situ, or CIN3, as its most severe manifestation) as a growth disorder that could culminate in cancer, Herb Green saw it as no more than a relatively benign developmental anomaly. Its sinister appearance under the microscope was, according to this interpretation, misleading. The clearest account of his perception of the pathology was provided at the inquiry by a couple of his patients (Patient Codes 4F1 and 4S, p 33 of the Report of the Cervical Cancer Inquiry. In essence: “we are born with cancer but it lies dormant”). It was a highly unorthodox interpretation, about which Herb Green wrote relatively little.
I was surprised that Dr Bryder had chosen not to interview the people who were involved with the inquiry, and especially, not to talk to Ron Jones. He had co-authored the original 1984 paper that led to the inquiry, and he had later collaborated with David Skegg, Charlotte Paul and others, to publish data which, for all practical purposes, now comprise the Results section of the original investigation. I think he would agree that this was how things started.
For some readers, Dr Bryder’s account of the social history may serve to balance the extravagant claims and hurtful accusations made in the media at the time of the inquiry. But like Herb Green’s pathology, her science would have benefitted greatly from discussion with others.
Dunedin, New Zealand