Everyone take a bow

The NZ Skeptics cast the net wide for the 2011 Bent Spoon.

The NZ Skeptics have awarded their annual prize for journalistic gullibility to all those media outlets and personalities who took Ken Ring’s earthquake prediction claims at face value, thereby misinforming the public and contributing to 50,000 people leaving Christchurch with all the inconvenience, cost and emotional harm that caused.

We believe that it is the business of the professional media to ask pertinent questions on behalf of the public when presenting material as factual. We even have broadcasting standards which call for accurate reporting. Many, many media outlets and journalists failed the basic standards of their profession in failing to ask “where is the evidence?” in the face of Ken Ring’s claims to predict earthquakes. They did us all a disservice.

The group Bent Spoon award is an unusual one for the NZ Skeptics, but we felt that so little was asked by so many that it had to be a broader award this year. That said, we did single out some reporters and commentators whom we felt had made particularly poor journalistic efforts in this area. They include:
Marcus Lush (RadioLIVE), for giving great and unquestioning publicity for Ring’s claims that Christchurch would have a major earthquake – “one for the history books” – on 20 March, and continuing to support Ring’s promotion as an earthquake predictor and weather forecaster.
Closeup’s Mark Sainsbury for giving Ring another platform to air his ideas with very little in-depth critique (12 July).

The best thing about Ken’s failure on March 20 was his long silence afterwards. Yet there he was back on what is supposed to be a credible current affairs show with more vague pronouncements and self-justifications. Surely Closeup had another Kate-and-William clip they could have played instead to maintain their level of journalistic quality.

The Herald on Sunday’s Chloe Johnson, who provided uncritical publicity for Ring which continued long after his failures had been well and truly demonstrated (26 June).

It’s been sad to see the Herald name devalued by the tabloid approach of the Herald on Sunday, especially when the spin-off can sometimes do good stuff such as its hard-hitting editorial headlined “Charlatan Ring merits contempt” (20 March).

Brian Edwards, described by one commentator as providing ” banal and rigourless equivocations”, including such gems as “the evidence that the moon has some contributory influence on earthquakes seems slight … however, it is not impossible that it does”.

We’ve seen Edwards cogently skewer sloppy thinking in the past, so it was surprising to see just how wishy-washy he was in this particular case.

And what of the notorious John Campbell interview where the television interviewer lost his cool and boosted sympathy for Ring by shouting him down? This has given us the unusual situation of seeing nominations come in to give Campbell both the Bent Spoon and the society’s Bravo Award for critical thinking.

We appreciate what John was trying to do – introduce a little evidence and call into question some very dubious claims – but we knew he’d blown it as soon as he started to talk over the top of Ken.

Bravo Awards

The NZ Skeptics also applaud critical thinking with a number of Bravo Awards each year. This year’s recipients are:
Janna Sherman of the Greymouth Star for her item “Sceptics revel in Hokitika ‘earthquake’ non-event” (14 March). Ken Ring predicted an Alpine Fault rupture and/or an extreme weather event which would require Civil Defense to prepare for gales and heavy rain at the Hokitika Wildfoods Festival in March. As Sherman’s report noted:

“The 22nd annual Wildfoods Festival on Saturday was held under sunny skies, with temperatures climbing over 20 deg C.”

In science, a lack of evidence or a failed prediction can tell us a lot; in the media, we rarely see any stories about a non-event. That’s why it was great to see Sherman and the Star cover Ken’s failure – pseudo-scientists and psychics alike will only trumpet their successes as part of their self-promotion. To get the real picture, you need to hear about their failures too.

Philip Matthews, writing in the Marlborough Express, for a great article on 1080 that actually says there is really only one side to the story rather than introducing an alleged controversy with token ‘balance’ (22 June).

We don’t ask the Flat Earth Society to provide balance for a story on the International Space Station orbiting a spherical Earth. Why should we give a false impression of evidence-based ‘debate’ in other areas such as 1080 or immunisation? In discussing the entrenched views regarding the use of 1080, Matthews wrote:

“One of those ‘entrenched views’ is the weight of science; the other, emotive opinion. The debate is done a disservice by suggesting the views are somehow equivalent.”

The NZ Skeptics also commend Dr Jan Wright, the Parliamentary Commissioner for the Environment, who, while not in the media itself, did a great job of evaluating the evidence on 1080 and presenting a report clearly outlining the evidence.

As always, the Bent Spoon was awarded telepathically by those gathered for the annual NZ Skeptics Conference.

Truth is the daughter of time, and not of authority: Aspects of the Cartwright Affair

The ‘Unfortunate Experiment’ at National Women’s Hospital has entered the national folklore as a notorious case of medical misconduct. But there is still disagreement about what actually happened.

It is 22 years since the Cartwright Inquiry published its findings. Arguments about the whole affair persist, with repeated public support from those who say it was a valuable and proper exposure of damaging improprieties by the medical profession, and from those who say that the inquiry and the events which led to it are based on an erroneous interpretation of a scientific paper, and selective evidence gathering at the Inquiry.

If indeed an error has been made, then the vilification of the medical people involved, which has occurred and which still goes on, must be redressed.

I want to consider two aspects of this affair, and if the evidence shows a miscarriage of justice, to offer reasons as to why this might have happened.

I shall:

  • consider the contention that an unethical experiment was performed at National Women’s Hospital (NWH) by Professor Green and his associates, and whether or not the Inquiry made a fair and just assessment of the current (1988) internationally accepted management of carcinoma-in-situ of the cervix (CIN3);
  • discuss what factors in our scientific literary world might be contributing to error.
  • describe unwelcome aspects of our human behaviour which allow an issue of this magnitude to survive in our society, unresolved for 22 years, and how writers have described these for many centuries. I have chosen as my title a quotation from Aulus Gellius in his Attic Nights, written in c.150 CE to emphasise the long-standing nature of the problem.

It is important to have a clear outline of the sequence of events over time at NWH and here is a timeline for reference:

1966: Green proposed to the NWH Medical Committee that CIN3 should be managed by cone biopsy if indicated and regular review. This was in response to considerable doubt worldwide about the natural history of the condition, for which many advocated hysterectomy. The committee agreed.

1973: Editorial in the British Medical Journal, “Uncertainties of Cervical Cytology.”1

1974: Article in New Zealand Medical Journal (NZMJ) by Green showing evidence that “The proportion progressing to invasion must be small.”2

1975: The NWH Medical Committee reviewed the management protocol and agreed it should continue.

1982: Professor Green retired.

1984: “The Invasive Potential of Carcinoma-in-situ of the cervix” was published.3 This was the paper on which Sandra Coney and Phillida Bunkle based their Metro article.

1985: A letter to the NZMJ by Skrabanek and Jamieson was critical of a national cervical screening programme for CIN3 as a detection and treatment method for carcinoma of the cervix (14 August).

1986: A letter from David Skegg was published in the NZMJ supporting a cervical screening programme. “The case for the effectiveness of screening does not rest on the unfortunate experiment at NWH in which women with abnormal smears were treated conservatively and a proportion have developed invasive cancer” (22 January).

1987: “An Unfortunate Experiment at National Women’s” appeared in the June issue of an Auckland magazine,Metro. Within 10 days the Minister of Health (Michael Bassett) has announced the inquiry, and that it was to be chaired by Sylvia Cartwright.

1987/1988: The inquiry sat, and published its report in 1988.

1988: A book, An Unfortunate Experiment, by Sandra Coney was published.

1990: Jan Corbett, a journalist, wrote an article in the July issue of Metro reviewing the errors in the Coney and Bunkle paper, and the way in which the data in the 1984 paper had been distorted.

2008: A conference was held to commemorate the Cartwright Inquiry. A number of papers including Charlotte Paul (a medical adviser to the inquiry), and Sandra Coney, were presented endorsing the inquiry findings.

2009: A book, A History of the ‘Unfortunate Experiment’ at National Women’s Hospital, by Linda Bryder, a professional historian, was published.

2009: A book, The Cartwright Papers, published by participants in the 2008 conference, and now including a vehement criticism of Linda Bryder and of her book.

2010: The NZMJ publishes a letter from Dr Helen Overton, “In defence of Linda Bryder’s Book.”4

The 1984 paper

“The Invasive Potential of Carcinoma-in-situ of the Cervix” was written by two gynaecologists from NWH (McIndoe and Jones), a pathologist from NWH (McLean) and a statistician (Mullins).

I have read this carefully, and made a summary of its contents. It described the follow-up data for 948 women with carcinoma-in-situ of the cervix. The women were followed for five-28 years by repeated smears and observation according to the 1966 proposal, unless they showed evidence for spreading cancer. The women were seen at three, six, and 12 months after presentation, and yearly after that. The women’s records showed that at 24 months after presentation, 131 continued to have an abnormal smear. (Of course, the other 817 had normal smears, or had had removal of the cervix by hysterectomy or other treatment.) There was no difference in age or parity between those in either group.

The division into the two groups was made retrospectively by the authors on the evidence for the presence or absence of an abnormal smear at 24 months.

They compared the outcomes in the two groups in terms of the development of invasive cancer (22.1 percent in the group with positive smears at 24 months, 1.5 percent in the larger group). They also compared the number of deaths in each group at the end of the observation period (June 1983). Four women who had had normal smears at 24 months had died (0.5 percent) and eight women had died who had had abnormal smears at 24 months (6 percent).


There was no withholding of treatment in that group with the persistently abnormal smears – see Table 1.

Initial treatment Eventual treatment
Total hysterectomy Cone biopsy or amputation Total hysterectomy Cone biopsy or amputation
Group 1 (n=817) 217 (26.6%) 576 (70.9%)
Group 2 (n=131) 33 (25.2%) 88 (67.2%) 62 (47.3%) 166 (126.7%)

Table 1. Initial and eventual treatment of patients with normal smears, or who had cervixes removed by hysterectomy or other treatment (Group 1), and of patients with persistent abnormal smears (Group 2). Percentages exceeding 100 percent reflect the need for two cervical procedures in some women.
The authors said in the paper’s discussion, “the almost universal acceptance of the malign potential of this lesion has made prospective investigation into the natural progression of CIS ethically impossible”. That would require an experiment where women had no treatment. This is quite clearly not the case in this reported series.

It is clear that in this report of the management of CIS there is no evidence of withholding of treatment, nor of an experiment.

Three years after this paper was published, it was used by Sandra Coney and Phillida Bunkle as evidence for gross wrongdoing by the medical staff at NWH. Here is what they wrote:

“The study divided the women into two groups – 817 who had normal smears after treatment by conventional techniques, and a second group of 131 women who continued to produce persistently abnormal smears. This group is called in the study the conservative treatment group. Some had only biopsies to establish the presence of disease and no further treatment.”

Later in the article the authors refer to “group two women who had little or no treatment”.

This paper in a popular magazine was used by the Cartwright Inquiry as some of the evidence which led to its conclusions.

In 1990, Liggins said, “The famous 1984 article which emanated from the National Women’s Hospital and on which the Metro article which stimulated the cervical cancer inquiry was based, was misinterpreted by the authors of the Metro article and by the judge”.5

Was the management of cervical carcinoma-in-situ unethical?

This is the second aspect of the Cartwright affair that I wish to examine. In June 2010 the statement was made that “treatment with curative intent was withheld in an unethical study” at NWH from 1965 to 1974.6

It is important to make clear what we understand by ‘ethical’, ‘unethical’ and ‘conventional’, or we shall be reduced to the state of the Looking-Glass world: “‘When I use a word,’ Humpty Dumpty said in a rather scornful tone, ‘it means just what I choose it to mean – neither more nor less.'”7

Ethical: “In accordance with principles of conduct that are considered correct, especially those of a given profession or group”. (Collins Concise Dictionary, 1988.)

Unethical: Not in accordance with these principles.

Conventional: Relating to convention or general agreement. (OED)

Convention is a general agreement or consent. (OED)

Was the protocol for the management of CIN3 by Prof Green and his colleagues at NWH an unethical experiment? If he had proposed to divide the women as they presented into two groups, one of which was treated and the other not, then that would have been unethical. Although uncertainty existed as to what proportion of women with an abnormal cervical smear developed an invasive cancer, it was agreed that an abnormal smear meant that the woman was more likely to develop cancer than if she had a normal smear.

His protocol did not deny women treatment.

There was widespread international uncertainty as to the best form of management. If Prof Green had withheld an acknowledged proven treatment that was agreed to by the majority of workers in the field, and replaced it with an unproven treatment, then that would indeed have been unethical.

He didn’t do that.

During 1966-1984 there was no international agreed conventional treatment for this condition. As Iain Chalmers of the James Lind Library in Oxford points out, 8 Linda Bryder in her book has made a thorough review of the contemporary medical literature on this subject which makes it clear that there was no worldwide, generally accepted treatment of CIN3. The evidence called by the Cartwright Inquiry did not reflect the lack of an international consensus. It was indicative of only one aspect of the issue. It has all the attributes of ‘cherry-picking’.

The accusation that Green and his colleagues behaved unethically in these matters is not sustainable. Unless his detractors can show that there was a single international conventional treatment which he ignored, then repeated accusations of “unethical behaviour” are wrong. These accusations continue to be made, as recently as 1 June, 2010.6

Why do manifestly false beliefs persist over time?

There are features of our human behaviour which are conducive to the persistence of untruths, and they include a desire for uniformity in the interest of the maintenance of a coherent and more easily managed society.

Once a decision has been made, it is easier for all of us to go along with it, and not to ‘rock the boat’.

There have been trenchant criticisms of the Cartwright affair and its outcomes, often met with strident objections and not much logic. To accuse the whistle blower of “intransigence and arrogance” rather than meet the questions fairly is shameful.

Another feature of the last 22 years is the increasing number of papers published in the medical literature which on close examination are of poor quality. An example of this is the paper published on 1 June, 2010.

This was published as an abstract online. The authors include a medical adviser to the Cartwright Inquiry, a medical witness at the inquiry, and one of the authors of the 1984 paper. There is the old accusation that “treatment with curative intent was withheld in an unethical clinical study of the natural history of CIS at NWH in the years 1965-1974.” But in the results it is stated that 51 percent of these women had treatment with curative intent! The group treated with the diagnosis made in 1975-1976 had curative intent treatment in 85 percent. Prof Green retired in 1982; his proposal for the management of carcinoma in situ was approved in 1966.

Treatment with curative intent was not defined in the abstract.

The results include P values of 0.0005 for the significance of differences between groups, for a difference which defines the grouping.

The number of new patients in the year 1975-1976 was half that in each of the two previous decades. There is no explanation for this in the abstract. This group was not included in the comparison of risk for cancer of the cervix or vaginal vault. There is no explanation for this.

The medical science literature shares with all scientific paper publishing a current deterioration in standards. This contributes to the persistence of error. This issue has been recently addressed in an editorial in The European Journal of Clinical Investigation.9

“Why would scientists publish junk? Apparently the current system does not penalise its publication. Conversely, it rewards productivity.
Nowadays, some authors have been co-authoring more than 100 papers annually. Some of these researchers only published three or four papers per year until their mid-forties and fifties. Then suddenly they developed this agonising writing incontinence.”

Another factor in our society which feeds our appetite for orthodoxy is the popular press. Truth is often submerged in the sensational. An example of this occurred in the NZ Herald on 1 June, when their health reporter wrote a report of the on-line article6 with the headline:

“Otago research backs cancer inquiry findings: Unfortunate experiment at National Women’s not imagined, says report”

There followed 40 column centimetres supporting the headline, including two which stated: “The cancer death rate differences between the periods and sub-groups are not significantly different”. This information is not included in the on-line published paper. The reporter’s statement is not correct in his summary of the report. In addition he cites information which suggests he has access to the complete (as yet unpublished on June 1st) paper.

The television ‘press’ included that morning an interview with Charlotte Paul, one of the authors, and that evening, an interview with Clare Matheson, the woman named as ‘Ruth’ in the original Metro article. There was no reference to the valid criticisms of the Cartwright affair which have been made over the years.

It is not my case that the medical profession to which I belong is without fault, and I accept that since 1988 more attention has been paid by doctors to issues such as informed consent. But the means, by this miscarriage of justice, do not justify the ends.

Our human desire not to alter our beliefs in the face of contrary evidence, the willingness of the popular press not to disturb established ‘truth’, the current deterioration in the standards of the world medical press, and an unquestioning respect for ‘authority’ are factors recognisably active in the persistence of the myths surrounding the Cartwright affair. These behaviours are not new, and their effects on the emergence of truth have been recognised for centuries. Francis Bacon (1561-1626) in his Axioms wrote, in number 46:

“The human understanding when it has once adopted an opinion (either as being the received opinion, or as being agreeable to itself) draws all things else to support and agree with it. And though here be a greater number and weight of instances to be found on the other side, yet these it either neglects and despises, or else by some distinction sets aside and rejects; in order that by this great and pernicious predetermination the authority of its former conclusions may remain inviolate.”


  1. Editorial. 1974: BMJ, 5891, 561-2.
  2. Green, GH. 1974: NZMJ 80, 279-287.
  3. McIndoe, WA; McLean, MA; Jones, RW; Mullins, PR. 1984: Obstetrics and Gynecology 64, 451-458.
  4. Overton, H. 2010: NZMJ 123, 95-96.
  5. Liggins, CC. 1991: Australia and New Zealand J. Surgery 61, 169-172.
  6. McCredie, MRE; Paul, C; Sharples KJ; Baranyai, J; Medley, G; Skegg, DCG; Jones, RW. 2010: Australia and New Zealand J Obstetrics and Gynaecology, ‘earlyview’ on-line 1 June.
  7. Carroll, L. 1871: Through the Looking-Glass. Chapter 6.
  8. Chalmers, I. 2010: NZMJ Letters to the Editor. 30 July.
  9. Editorial. 2010: European J Clinical Investigation 40(4), 285-7.

An alien star-child?

Waikato University biological sciences lecturer Alison Campbell posts a regular blog on matters biological (sci.waikato.ac.nz/bioblog/). Her aim is to encourage critical thinking among secondary students. We think these need sharing.

Last week one of my students wrote to me about something they’d seen on TV:

My friend and I saw this on Breakfast this morning. Although we don’t think it is all true, we are still interested because they talked a lot about the skull’s morphology and how they believe it is the offspring from a female human and an alien. Here’s the website on it: www.starchildproject.com

It would be great to hear your thoughts.”

So I went off and had a look at the website, and wrote back. My first thought is that (following what’s called ‘Occam’s razor’) the simplest possible explanation is likely to be correct, ie that this is simply a ‘pathological’ human skull, rather than a mysterious alien-human hybrid. (Read Armand LeRoy’s book Mutants to get a feel for just how wide the range of potential variation is in humans.)

Happily there are ways of testing this – the skull is reportedly only 900 years old so it should be possible to look at its DNA.

And indeed this has been done – and the data are presented on the Starchild project’s website. Which surprised me more than a little, given that they don’t support the hybrid idea! The skull in question – which certainly has an interesting shape – was found along with the remains of an adult female. The DNA results show that both woman and child were native Americans, not related to each other, and also that the child was male. There is absolutely no indication there of any ‘alien’ DNA. Which is what I would have predicted – if we were to be visited by extraterrestrial individuals, why would we expect them to be a) humanoid and b) genetically compatible with us? ie the likelihood of successful interbreeding is vanishingly small. And that’s a big ‘if’ in any case … Carl Sagan had some sensible things to say on that issue in The Demon-haunted World.

My personal view is that the whole thing should have been examined rather more critically by the programmers before it made it to air. But then, I have ceased to be surprised at the uncritical nature of much that’s presented by our broadcast media (with the honourable exception of the National Programme!).

TV3 – the best of news, the worst of news

It’s Bent Spoon time again-the time when the Skeptics highlight the worst-and best-of the year’s media.

In the first double-header of its kind, one organisation has won both brickbats and plaudits from the NZ Skeptics Society in its 2007 Bent Spoon and Bravo Awards for gullibility and critical thinking respectively-TV3 News and Current Affairs.

TV3´s Campbell Live programme took the Bent Spoon award for Carol Hirschfeld´s August 31 interview with self-proclaimed energy healer and clairvoyant Simone Simmons, who claims to be visited regularly by the spirit of Diana, 10 years after the death of the Princess of Wales.

Promotional material provided by Simmons´s publicist cites her appearance on television in New Zealand and elsewhere as endorsing her claim to be a “global psychic and personality”. Less complimentary was one reaction to Simmons´s Diana ‘tell all’ book, when Guardian columnist Mark Lawson called it “rubbish even in a genre that has redefined the meaning of garbage”.

Her appearance on the Campbell Live programme did nothing to cement TV3´s claim to offer `leading news journalism´. It´s a shame really because we know Campbell Live can do quality current affairs, but they certainly didn´t live up to any standards of excellence in reporting, story telling or research with this one.

It is important to strongly challenge psychics regarding their claims, because it´s an industry like any other and should be called to account. Otherwise you end up with people believing they are getting value-for-money when they ring psychic hotlines, like the Victoria University Students Association Women´s Rights Officer who spent thousands of dollars of student union money ringing psychic 0900 numbers earlier this year.

Research on how women, in particular, are preyed upon economically and psychologically by the psychic industry was covered at the recent Skeptics Conference, in Christchurch, and a news item covering local research into this has won TV3 reporter Tristram Clayton a Bravo commendation.

Clayton´s Psych Addictive item (July 17) gained praise for providing a seldom-seen critical look at the million-dollar 0900 psychic phoneline business. A recent study by Auckland University psychologist Dr Robin Shepherd revealed women who became psychologically dependent on the psychic hotlines were spending more than $7000 annually each, and not for entertainment purposes either. Shepherd gains a Bravo Award for her study, which is seen as providing hard-to-get data on the exploitation involved in the psychic phoneline industry.

Clayton also won plaudits for items on the establishment of a UFO database and reporting on the Therapeutic Products and Medicines Bill.

We´ll be watching his future career with interest. Perhaps he can teach the old hands at Campbell Live a thing or two about story selection and follow-up. If TV3 feels it must fill its news programming with such soft items, the least they can do is bring some journalistic integrity to it.

The controversy over the Therapeutic Products and Medicines Bill provided multiple nominations for the Skeptics to consider. The attempt to provide standards and accountability in this lucrative trade saw Minister Annette King and industry group Natural Products New Zealand gain Bravo Awards.

We don´t often give awards to politicians, and we don´t often see vested interests providing leadership of this nature, so it´s good to recognise good work when it does happen even if, in this case, it was ultimately unsuccessful.

It is important for complementary and alternative medicines in New Zealand to be appropriately regulated to provide broad consumer protection, whether quality control in product manufacture, truth in advertising, or evidence-based comparisons of the effectiveness of outcomes against other treatments.

The Bent Spoon is named after the infamous symbol of self-proclaimed psychic Uri Geller, and was formally confirmed telepathically by the assembled Skeptics at their annual conference, along with Bravo Awards recognising critical thinking in the media.