Herb Green

Dr George Herbert Green, B.A., B.Sc., M.B.,Ch.B., (D.Obs. R.C.O.G.), M.R.C.O.G.(Lond.), was a New Zealand Obstetrician and Gynaecologist who led the National Women's Hospital Cervical Cancer Unit as Professor through the 1960s and 1970s and became notorious for conducting an alleged unethical experiment that was the subject of the Cartwright Inquiry.

Biography

Dr Green was born in the rural South Otago town of Balclutha, New Zealand on 16 November 1916 and attended South Otago High School, where he studied University papers before even leaving high school.[1] He later said that one of his teachers died of cervical cancer, and this sparked his life-long interest in the disease.[2]

University

He attended the University of Otago and earned a B.A. in 1938,B.Sc. (including pure and applied mathematics) in 1940, before studying Medicine.[3] He graduated with M.B.,Ch.B. in 1946, the same year as Sir Brian Barratt-Boyes.

Post-Graduate Study

Dr Green worked at the National Women's Hospital as a House Officer and Registrar from 1948 to 1950. In 1948 he passed the RCOG Diploma in Obstetrics, scoring one to the top three scores in the exam. As a registrar he was reported to show an aptitude for statistics and analysis. He gained RCOG Membership in 1950.

In 1951 he went to work and study in the U.K., where he worked at the Queen Elizabeth Hospital in Newcastle upon Tyne.

Work

In 1955 Green returned to work as Consultant Obstetrician at Wanganui Hospital in New Zealand. In 1956, while attending a training course at the National Women's Hospital, he was recruited back to work there as a Consultant. He shifted back there in 1956, joining the 'D' team which was primarily responsible for treating reproductive tract cancers.[2]

Death

He died in St John's Hospital, Auckland on 4 March 2001.[4][5]

The Unfortunate Experiment

George Herbert "Herb" Green (1916–2001) was the doctor at the centre of the Cartwright Inquiry, a commission set up to examine claims that he had been illegally experimenting on patients without their consent between 1966 and 1987 (continuing after his retirement in 1982). The inquiry found that he had conducted a study between 1966 and 1987 in which the cases of women with major cervical abnormalities were followed without definitive treatment, in an attempt to prove his "personal belief" that these abnormalities were "not a forerunner of invasive cancer."[6] According to Judith Macdonald, a researcher at the University of Waikato, Green was strongly opposed to abortion,[7] and his distaste for anything that reduced a woman's fertility was evident in his discussions with patients and his avoidance of the treatments available at the time (hysterectomy or cone biopsy).[1] This suggestion was refuted by Green and other witnesses at the Inquiry, and a recent history has questioned its validity.[2]

After Green retired, a paper[8] was published in 1984 discussing the outcome of Green's management of his patients. This paper came to the attention of Phillida Bunkle and Sandra Coney, who published an article entitled "An Unfortunate Experiment" in Metro Magazine in June 1987.[9] (The full phrase "an unfortunate experiment at National Women's Hospital" first appeared the year before in the New Zealand Medical Journal, in a letter from Professor David Skegg.[10]) The main media then used the term "unfortunate experiment" extensively.

Defenders of Green argue that there was no experimentation, with or without patients' knowledge; that the allegations that he divided patients into two groups, one of which was treated, and one of which was not, was false (his patients were treated on a case-by-case basis); that he did not withhold treatment from patients; that his methods of treatment were not substandard, and have in fact come to be regarded as the international standard.

A 2010 study comparing patients diagnosed with cervical carcinoma in situ during Green's study period with those diagnosed beforehand and afterwards (the three periods being 1955-64, 1965-47 - the 'study period', and 1975–76). This study found that his patients were at substantially greater risk of cancer and were subjected to numerous extra tests that were intended to observe rather than treat their conditions. The authors failed to recognise that these patients had been treated by one of the twenty or so consultants at the hospital and not exclusively by Green. The study concluded that eight of the eleven deaths among the women followed up occurred in the group who received punch or wedge biopsy as their initial management, but admitted that 'the numbers of deaths were too small to make reliable comparisons'.[11][12] This publication along with the publication in 2009 of a history of the Cartwright Inquiry sparked an extensive debate in the New Zealand Medical Journal in 2010, including 39 letters to the editor and three editorials, one by the author of the history, Professor Linda Bryder, who argued that the 2010 retrospective study did not, as alleged, settle the debates about what happened at National Women's Hospital, and nor did it 'prove' that 'treatment of curative intent' had been withheld at the hospital.[13] Green graduated from Otago Medical School in 1945 and retired in the early 1980s, before the publication of the article in Metro. His specialities were gynaecology and obstetrics and he wrote a textbook on the subject that underwent several revisions.

Notes

  1. ↑ 1.0 1.1 "Obituary:Dr George Herbert GREEN". O & G 3 (3): 223. September 2001. Retrieved 4 March 2015.
  2. ↑ 2.0 2.1 2.2 Bryder, Linda (2009). A History of the 'Unfortunate Experiment' at National Women's Hospital. Auckland University Press. pp. 52–55. ISBN 978 1 86940 435 2.
  3. ↑ "University of New Zealand Graduates 1870-1961". http://shadowsoftime.co.nz/''. Retrieved 17 March 2015.
  4. ↑ New Zealand Herald 2001; Death Notice 6 March page C14 & Obituary 8 March page A3
  5. ↑ "'Unfortunate experiment' doctor dies". Television New Zealand. 8 March 2001.
  6. ↑ "Cartwright Inquiry - Summary of findings and recommendations".
  7. ↑ Macdonald, Judith. ""The Hidden Bits": Understanding Cervical Screening" (PDF). p. 2. Archived from the original on 2007-10-08. Retrieved 5 March 2007.
  8. ↑ McIndoe, William A.; McLean, M.R.; Jones, R.W.; Mullins, P.R. (1984). "The invasive potential of carcinoma in situ of the cervix". Obstetric Gynecology 64: 451–458.
  9. ↑ Heslop, Barbara (6 August 2004). "‘All about research’—looking back at the 1987 Cervical Cancer Inquiry". New Zealand Medical Journal 117 (1199).
  10. ↑ Jones, Ronald; Fitzgerald, Norman (26 November 2004). "The development of cervical cytology and colposcopy in New Zealand: 50 years since the first cytology screening laboratory at National Women’s Hospital". New Zealand Medical Journal 117 (1206).
  11. ↑ ""Unfortunate experiment" led to eight deaths". One News. 2 June 2010. Retrieved 3 October 2011.
  12. ↑ McCredie, Margaret R.E.; Paul, Charlotte; Sharples, Katrina J.; Baranyai, Judith; Medley, Gabriele; Skegg, David C.G.; Jones, Ronald W. (2010). "Consequences in women of participating in a study of the natural history of cervical intraepithelial neoplasia 3". Australian and New Zealand Journal of Obstetrics and Gynaecology 50 (4): no. doi:10.1111/j.1479-828X.2010.01170.x. PMID 20716265.
  13. ↑ Bryder, Linda (2010). "A response to criticisms of the History of the 'Unfortunate Experiment' at National Women's Hospital". New Zealand Medical Journal 123 (1319): 14–21.

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