Herb Green


George Herbert "Herb" Green, B.A., BSc, M.B., Ch.B.,, M.R.C.O.G., 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

Green was born in the rural South Otago town of Balclutha, New Zealand. He attended South Otago High School, where he studied University papers before even leaving high school. He later said that one of his teachers died of cervical cancer, and this sparked his lifelong interest in the disease.

University

Green attended the University of Otago and earned a B.A. in 1938, BSc in 1940, before studying Medicine. He graduated with M.B., Ch.B. in 1946, the same year as Sir Brian Barratt-Boyes. While at University he gained a Blue in Rugby, and also represented Southland in Cricket. He was described as "a powerfully built man who towered over his colleagues".

Post-Graduate Study

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 third highest 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 New Zealand, as Consultant Obstetrician at Wanganui Hospital. 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. Whilst becoming the senior consultant in D team it is an exaggeration to say that he saw "nearly every woman who came to the hospital with invasive cancer and many of those with the earlier or precursor stages", as was claimed around the time of the Inquiry.
He was concerned about risks of surgery leading to infertility, and Cartwright refers to him being "increasingly concerned at the number of young women undergoing hysterectomy for the disease which he regarded as unnecessarily radical". Journalist Sandra Coney states that "He wanted to save women from mutilating surgery and to do so he had to prove what at first he had suspected and eventually came to believe: that CIS was a harmless disease which hardly, if ever, progressed to invasive cancer.".
Outside of his cervical cancer work he was an early proponent of the Pap smear, although not necessarily of population-based screening programmes. He was also anti-abortion, and opposed sterilisation without women's consent.
Green retired in 1982, although still actively engaged in academic debate to criticism from Skegg in 1985, but by the time of the Cartwright Inquiry in 1987, he was quite frail, ending up in hospital with pneumonia after several days of questioning.

Death

Green died in St John's Hospital, Auckland on 4 March 2001.

"The Unfortunate Experiment"

Green was the doctor at the centre of the Cartwright Inquiry, a commission set up to examine claims that he had been experimenting on patients without their consent between 1966 and 1987. The inquiry argued 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." A subsequent history by Linda Bryder found that Green's views, far from emanating from a personal belief, arose from his wide reading of the international literature which was questioning aggressive approaches to abnormal cells of the cervix or what was then called Carcinoma in situ. According to Judith Macdonald, a researcher at the University of Waikato, Green was strongly opposed to abortion, and that this influenced his views on management of abnormal cells of the cervix. This suggestion was refuted by Green and other witnesses at the Inquiry, and was explored in Bryder's history.
After Green retired, a paper was published in 1984 summarizing the fate of women diagnosed with carcinoma in situ at National Women's Hospital between 1955 and 1976. 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. From that time forward, media articles used the term "unfortunate experiment" extensively.
Defenders of Green argue that there was no experimentation, with or without patients' knowledge; that the allegation by Coney, Bunkle and others that he divided patients into two groups, one of which was treated, and one of which was not, was false ; 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 compared patients diagnosed with cervical carcinoma in situ during Green's study period with those diagnosed beforehand and afterwards. This study claimed 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'.
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. Iain Chalmers reached a similar conclusion and pointed out the debt owed to Green by all those women who have avoided needless surgery and kept their fertility.
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.
In 2017, the New Zealand Committee of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists apologised to the women involved in the experiment. The perspective displayed in this action is symptomatic of the 'spells of explosive scandal and acrimonious conflict' outlined in relation to early cancer screening programmes by a new study of Screening, which in this case have persisted for over half a century. Raffle et al.’s new study provides an objective and in-depth analysis of the Cartwright Inquiry itself.

Publications

Books

Introduction to Obstetrics, George Herbert Green, Publisher N.M. Peryer, Christchurch, First Edition 1962

Journals