Hard News: A Real Alternative
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Craig, I don't want to get into another argument with you so early in the morning but I'm sorry even medical research is not a black and white, fact v opinion process.
There are questions about what level of clinical trial it is, resourcing issues, who pays, research design, statistical validity, supervision, and other issues about how the hypothesis will be tested, before you even get into informed consent.
There was no clear and transparent ethical approval process then as there is today where all these things get ticked off and reported on with a clear paper trail.
There was a distinct lack of communication, particularly with the women concerned, inadequate paper work, and other problems. Having no clear groups illustrates the sloppy process, rather than vindicating it.
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I haven't read the book yet, so I'm reserving judgement on that part of the argument, but I do get a little antsy at the idea that the medical establishment was 'naturally' moving toward a more informed patient approach. Women's health activists really fought for that stuff, and it was part of the wider feminist movement. It wasn't just beneficent medical administrations having lightbulb moments. (Just as the US civil rights movement wasn't solely a bunch of middle class white people having an epiphany.)
(Bryder may say this in her book, of course, in which case I take it all back. :) )
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There was a distinct lack of communication, particularly with the women concerned, inadequate paper work, and other problems. Having no clear groups illustrates the sloppy process, rather than vindicating it.
Hillary: I've got better things to do than argue with you too. But the simple matter of fact, which you've not rebutted, is that even Sandra Coney acknowledges there were never two groups of women, one deliberately under-treated. That's not a critique of methodology, or even saying his "bedside manner" sucked, but an allegation that was simply not true. And to me that actually matters.
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But the simple matter of fact, which you've not rebutted, is that even Sandra Coney acknowledges there were never two groups of women, one deliberately under-treated.
Can someone link to Coney acknowledging that please. I can also see I'll need to find time to read the flipping book..
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I haven't read the book yet, so I'm reserving judgement on that part of the argument, but I do get a little antsy at the idea that the medical establishment was 'naturally' moving toward a more informed patient approach.
To be fair, I don't think that's what Bryder was saying at all. I think it would a fair precis to say that she makes the case the debate in medical circles was a little more complex, and there's still a lot of debate around whether hysterectomy is a radical and profoundly invasive surgery that is too often unwarranted and unnecessary. You sure don't have to be a radical feminist to wonder if the picture would be somewhat different if over half a million men a year, in the United States alone, were getting their balls cut off
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And isn't history always about resisting the myth that the past is a tidy hall of dioramas with the white hats on one side, and the black hats on the other?
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Having no clear groups illustrates the sloppy process, rather than vindicating it.
To me, it demonstrated that the "experiment" didn't exist. That's what it says.
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Can someone link to Coney acknowledging that please.
According to Bryder, Coney said so in her own book.
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So... it was a group of medical professionals misinforming and undertreating women with cervical issues, some of which eventually led to cancer and death, but it wasn't a 'scientific experiment'.
You'll have to excuse me if I don't find that revelation particularly comforting!
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According to Bryder, Coney said so in her own book.
Crap - that's two books to read. :)
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So... it was a group of medical professionals misinforming and undertreating women with cervical issues, some of which eventually led to cancer and death, but it wasn't a 'scientific experiment'.
Danielle, have you read the Listener story and listened to the interview?
The two groups were solely a construction of a 1984 review of medical data from 1955-1976. The review divided them in a group (817) who, after testing positive for carcinoma in situ had reverted to a normal smear after 24 months, and the second (131) who still had an abnormal smear after 24 months. It had nothing to do with treatment.
To quote from the article:
Group 2 was not composed of women who after 24 months had not been treated, but of women who after 24 months had not been cured. Bryder points out that the so called "untreated" Group 2 women between them had "228 interventions -- ie, hysterectomies or cone biopsies -- so they could hardly be regarded as untreated."
But the idea of a group that was left deliberately untreated was also picked up by the inquiry. The Cartwright report quotes Coney and Bunkle's figures, finding: "Thus the women in the limited-treatment group were 12 times more likely to die than the treated group."
That was just wrong.
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Russell you just quoted Cartwright as saying "limited treatment".
Without having read the source material yet, surely that's not a claim of "no" treatment?
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I thought I already said I was talking out of my uninformed ass, Russell. :)
I find this all a bit odd. Is the consensus now that there was no actual wrongdoing at National Women's?
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There has been an ongoing and determined defense of Herbert Green by some for many years. Again, haven't had time to catch any of this recent material.
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Russell you just quoted Cartwright as saying "limited treatment".
Without having read the source material yet, surely that's not a claim of "no" treatment?
It's just that, on the evidence provided by Bryder, it was an invalid way of characterising the group. Group 2 was more likely to develop cancer because that was the group whose positive smears had not cleared up within 24 months.
It may be that the radical treatment was the wiser course of action, but as Bryder notes, a meta-analysis reported last year by the British Medical Journal found that women subjected to cone biopsies suffered a much higher rate of problems in subsequent pregnancies. In other words, the treatment itself carried significant risks.
I look forward to Coney's response, but I don't think that Bryder (or Jan Corbett, who wrote the "second thoughts" story in Metro) should be reflexively disbelieved.
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I find this all a bit odd. Is the consensus now that there was no actual wrongdoing at National Women's?
I'm already way out of my depth too, but Bryder's case that there was no experiment seems sound on the face of it.
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The simple fact that there were never two groups of women, one deliberately under-treated, is enough to confirm that Green was unfairly vilified. That fact is now not in contention, as even Coney acknowledges.
I'm just shaking my head in disbelief (and sadness), that anyone could dismiss that as a mere "sideline". Call me an old crank, if you must, but when it comes to my health care I appreciate the idea that facts are not optional extras.
From what I read, and I did read the entire article, the point the writer was making was that not only were Coney et al misleading in their report, but that people believed them, it became taken as fact and they never bothered correcting the original misconceptions. That bothers me.
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According to Bryder, Coney said so in her own book.
And if Bryder is dumb enough to try pulling a Coulter on that citation her academic career (along with the possibility of being published by a reputable academic press) should be over.
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From what I read, and I did read the entire article, the point the writer was making was that not only were Coney et al misleading in their report, but that people believed them, it became taken as fact and they never bothered correcting the original misconceptions. That bothers me.
Bryder also came across as being severely underwhelmed by the quality of MSM coverage of the Cartwright Inquiry -- and twenty years later I think it would be fair to say that there are plenty of academics (and PAS readers) who'd say that the quality of reportage of complex and soundbite-resistant health and public policy issues hasn't improved much. If at all.
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Oh yes.
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What staggers me is that the Cartwright inquiry replicated the error of the original Metro story, and enshrined this terrible falsehood as fact.
Me too, and from the anecdotal snippets included in the Listener article it would seem Bryder's view is that this reflects the adversarial lawyer-driven process, against the media-political background. Extending that just a little, the implication is that the inquiry was not about establishing the truth, that Silvia Cartwright did what was expected of her by the influential, did it well,. And then went on to higher judicial honours and the Governor-Generalship.
The contrast with that other 1980s judicial enquiry, Peter Mahon on the Erebus disaster, is spectacular. That maverick Justice saw his mission as establishing the truth of what happened. He achieved that or a very close approximation brilliantly, and got hounded out of the judicial system as a consequence.
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And what about the Gisborne inquiry a few years ago about botched diagnoses? Does that fit into the story too?
Here is a good summary of the Cartwright report - it's a lot more than just the two groups discussion - and there was a conference run by the Auckland University law faculty last year to mark 20 years .
If any sees or hears Sandra Coney replying to these new accusations please can you let us know.
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Hilary, I suspect you may also see a response from others involved at the time - like Ron Paterson and Rodney Harrison QC, for instance.
And yes, along with Gisborne it's part of larger and ongoing stories about the relationship between health practitioners and consumers; women and political power; evidence, quality and resources; media and public policy.
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Here is a good summary of the Cartwright report - it's a lot more than just the two groups discussion
Indeed, although some of it is specifically addressed by Bryder in the reports so far (the "world opinion" part, for example).
I'm still not inclined to dismiss the two groups element -- it was at the very centre of the story. But it does seem likely to me that patient practices were considerably improved in the wake of the Cartwright report.
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