Posts by James Green
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A ban on use of hands-free cell-phones while driving would be about as enforceable as a ban on thinking of sex while driving.
Actually, I think his point is that that makes banning the use of non-handsfree headsets tokenism, but tokenism that looks good.
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So slight diversion, an Otago psychologist, David O'Hare, ripped into the govt's cellphone ban exclusion on hands free headsets.
"Why do we do research? I mean, there's 15 or 20 years of science that show that the problem with cellphones is the conversation."
This from a guy who pulls in millions of dollars from NASA to study pilot decision making, and strategies to prevent errors. -
I remember watching it and finding it quite gripping, but I was also like WTF when they presented a forensic accountant. It's not like there is an international shortage of epidemiologists.
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@Rob -- Thanks. I've wasted a bit much time on this, so I'm glad it's been useful.
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Just found another paper Jones (2009) in Obstetrics & Gynecology (same Jones as earlier), with a few more interesting observations.
*McIndoe was reviewing Green's cases without permission *One of the reviewers of the McIndoe study wrote: "“This is an important paper. Dr. Green was the last vocal opponent to the concept of the intraepithelial phase of invasive squamous cell cancer. His unfortunate views received a ready forum at international meetings because it seldom failed to gather a crowd and he remained influential long after an overwhelming body of data made his views untenable. This paper should be the last chapter in the Green saga. The authors are correct in pointing out that it will probably be the last large series in which patients with CIS are followed prospectively. Let us hope that is true.”"(c.1984)
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if she's going to be bashed for relying on a published account of the number of children Matheson had
This is a little relevant to the topic at hand. I'm not planning to re-listen to the interview, but according to the notes I took, Bryder imho over-emphasised the chance of hysterectomy as alternative treatment (as I've noted before), and I think actually suggested that Matheson had 4 children after her initial contact with Green. This implies that Green's 'nontreatment' allowed her to have 4 children when she otherwise wouldn't have, and that many other women wouldn't have been able to have children. Bryder also argues the cone biopsy was invasive, and that Green spared them that. Except that it seems his ring biopsies tended to be a half-arsed cone-biopsy that didn't treat, and which tended to occur multiple times (6 in Matheson's case).
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And not because they would have "happened anyway" - that's surely Bryder's most insulting claim.
Actually, tentatively, I'd like to suggest that that might have been Bryder's most credible claim. That is not to discount the fact that the Cartwright enquiry was clearly the catalyst for NZ's change, and especially for the structures that we now have in place.
However, internationally, the drive to many of these changes had been stimulated by other headline cases. Similarly, the concept of patient-centred healthcare* dates back to at least 1980 I think.New Zealand might have been later to this party if not for Cartwright, but I suspect we would have arrived by now. For example, most medical journals now demand information on the ethics and consent process for publication.
*Incidentally, in the US, republicans may be pinching the term patient-centred healthcare as an opposite to government-centred healthcare!
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His comments on folate seem pretty solid as well.
http://tvnz.co.nz/national-news/folic-acid-in-bread-toast-now-2852263/video?vid=2852473
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@ChrisW -- I rather wish that there had been a follow-up question on the prospective assignment. I think yo're misinterpreting McIndoe et al., however. I don't get the impression that their study was done with Green's co-operation, so I assume that is why they took a retrospective approach in creating groups. Secondly, even under modern ethics jurisdictions, the requirement to retain study records is for 10 years only. The patient records were clearly kept, but it is entirely possible that Green's records relating to his research were not. Clarification on this would have been good.
Despite that, I still think that the "was there a control group?" is a bit of a red herring. Even if there wasn't one, the study would still qualify as a case series, which is a kind of uncontrolled experiment.
The herald article 'An unfortunate revision' is worth reading. Paul calls Bryder on a couple of misquotes, in terms of what was considered standard treatment in the 60s. It also notes that Bryder was wrong on the number of Clare Matheson's children (her source was Corbett's 1990 newspaper article!).
Also, somewhat in reference to Craig's earlier question, instead of a single cone biopsy that likely would have been the end of it, Matheson had 6 surgeries under general anaesthesia and 44 visits to NWH, had recurrent abnormalities when Green stopped checking her 16 years later, and eventually developed full blown cancer. That doesn't really match up with Bryder's portrayal of that case in the interview (or the book, apparently).
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You know Craig, I consider myself to have pretty thick skin, but I almost didn't come back to this thread when I saw you'd re-posted this morning. Thanks for being more cordial this morning.
Having listened to Charlotte Paul, I can now confirm the hysterectomy v. other treatment argument. On finding a Carcinoma In Situ (CIS), normal treatment would have been to cut it out (the cone biopsy), hoping to remove all the CIS, plus a margin of healthy tissue around it, to make sure it's all gone (rather like if you've ever had a mole removed). On the other hand, Green was likely to biopsy some of the CIS, but not remove it all (deliberately), and then continue doing this multiple times over several years. So Paul argues rather than a less invasive treatment, a series of invasive procedures that also didn't remove the problem (She also notes that the side effects from these multiple procedures would be worse than from a single procedure). Further, if he did find cancer in one of the later biopsies, he would re-analyse the earlier tests himself, and decide that they'd had cancer from the beginning, and exclude their data from his analyses.