Conclusion: An ‘Unfortunate Experiment’?

Abstract

Despite Associate Professor Herb Green’s rebuttal, the concept of the ‘unfortunate experiment’, first coined by epidemiologist Professor David Skegg in 1986, persisted in the following two decades, most recently in the press coverage of the 2008 Lancet Oncology article.¹ The Lancet article stated that unethical practices had occurred at National Women’s,² but did not convincingly prove that Green had no intent to cure his patients. Nor did it recognise the complexities and uncertainties attached to past medical decisions. Green advocated conservative treatment in response to CIS, a minimal or a wait-and-watch approach, based on the belief that most lesions of the cervix would not become invasive cancer, and that early radical treatment could be worse than the disease itself, which was after all based on a cytopathologic and not a clinical diagnosis. He was not alone in this belief; many other gynaecologists worldwide advocated a similar approach. The view that he was out on a limb, propagated by Coney and others at the time of the Inquiry, is not supported by a review of the international medical literature. For instance, the 1979 edition of Recent Advances in Obstetrics and Gynaecology, published just two years before Green retired, described the ‘discrepancy of opinion as to whether or not dysplasia of the cervix represents a separate disease process which seldom, if ever, progresses to invasive carcinoma’.³ Nor could one brush this off with the idea that ‘dysplasia’ was of lesser significance than CIS; as Ralph Richart said in 1981, ‘It is a dictum among pathologists that one man’s dysplasia is another’s carcinoma in situ.’⁴