Second time round for controversial hospital book

Palgrave Macmillan, an arm of global publisher Macmillan Group, is pushing ahead with Women's Bodies and Medical Science, a reprint due in December of A History of the 'Unfortunate Experiment' at National Women's Hospital by Linda Bryder.

The book, published here in August, created a storm of controversy and was criticised for inaccuracies and for misunderstanding the medical science involved.

"A large number of assertions have been made about the book, but we have been able to identify only a handful of minor errors, all of which will be corrected before the next printing," says Palgrave Macmillan's publisher for history titles, Michael Strang.

The errors to be corrected all relate to Clare Matheson - a patient at National Women's Hospital from 1964 to 1979, who later learned she was part of an experiment by Dr Herbert Green which withheld treatment from a group of women with carcinoma in situ, a precursor of cervical cancer.

Green erroneously believed carcinoma in situ was a benign condition and didn't inform the women about the aim of his research.

Strang says one of the corrections will be Bryder's assertion that Matheson "went on to have four children" after her time at National Women's.

In fact, she already had two children, born before she was admitted, with her third born in 1966. Strang says the error "derived" from the original June 1987 Metro article which blew the whistle on Green's practices. A number of New Zealand academics have already pointed out the excuse, which is similar to the one used by Bryder, doesn't wash. Good scholarship requires meticulous checking of facts say the academics, and the use of primary sources such as Matheson's medical file which was available, rather than unattributed journalism references.

The Metro article also led to a judicial inquiry headed by Dame Silvia Cartwright, currently presiding over the Khmer Rouge trials in Cambodia.

Judge Cartwright found as a consequence of the "experiment" at the hospital many women developed invasive cancer and some died. Bryder's book, arguing Green was doing nothing wrong, attacks the integrity of Dame Silvia's judicial process.

Matheson, who wrote to Palgrave several weeks ago but has yet to get a response, is pleased three of the errors she outlined are being corrected. But she is concerned Palgrave is not correcting the book's misrepresentation of her condition - that Green discharged her from hospital knowing she had some form of carcinoma present which subsequently developed into invasive cancer, resulting in intrusive radiation treatment and radical hysterectomy.

Charlotte Paul, Professor of Preventive and Social Medicine at the University of Otago, has also written to Palgrave. She too has highlighted errors such as describing microinvasive carcinoma of the cervix as "A5 smears" when in fact such a diagnosis can only be discerned from a tissue sample.

Paul, who was a medical adviser to the inquiry, points out such errors may seem minor but they demonstrate a fundamental misunderstanding of the medical science - in this case the difference between cytology (cervical smear) and histology (tissue sample).

She, and other academics including Otago University vice-chancellor Sir David Skegg, say Bryder, a professor of history at Auckland University, was similarly muddled about the differences between lesser degrees of cervical cellular abnormalities (dysplasia) and greater degrees such as carcinoma in situ. It's a misunderstanding that fails to realise that though there can be difficulties telling the two types of abnormalities apart using smear tests, tissue samples provide enough information to decide what treatment is required.

Asked whether any of these concerns would be addressed in the reprint, Strang says the manuscript was reviewed by both the New Zealand publisher, Auckland University Press, and Palgrave, and by readers with a medical science background familiar with the Cartwright Report.

"In view of the nature of the subject material, and the fact that it is being published by two separate presses, it was subjected to a much more rigorous review process than normal."

The Herald has applied under the Official Information Act for access to the reviews provided to Auckland University Press.

Professor Paul has written a detailed critique of the book which she has offered to Palgrave. It outlines errors including contradictory accounts of Green's experiment, incorrect figures about women who developed cancer, and repeated omissions from quoted references

Palgrave has yet to respond.