Eva Peron and her doctors' deceit

By DR. LAWRENCE K. ALTMAN, New York Times

© St. Petersburg Times, published June 12, 2000

The wife of the Argentine president had cervical cancer, but she never knew it. Why? Politics.

When Eva Peron, the first lady of Argentina, underwent a hysterectomy in November 1951, she did not know that her husband, Juan, had summoned a Manhattan cancer surgeon to perform the procedure. The surgeon, Dr. George Pack, flew to Buenos Aires, entered the operating room after Eva was anesthetized and left before she awoke.

A month earlier, using the same secret ritual, Pack examined an anesthetized Eva to confirm the cervical cancer that Argentine doctors had detected.

The deceit was to keep the cancer secret from Eva and the public during a presidential campaign. Eva's efforts for the poor made a powerful political figure of a woman whose fame was later perpetuated as Evita in a Broadway musical and movie. News that she had a potentially fatal illness could have affected the election's outcome.

The childless Eva underwent both procedures in the belief that she had vague female problems. She never knew she had cancer.

Eva's medical ordeal began in January 1950, when she was 30. She fainted and underwent an appendectomy. Despite persistent weakness and anemia from vaginal bleeding, she delayed further tests. In August 1951, Eva, much weaker, developed increasingly severe abdominal pain and fainted again. A physical showed she had advanced cancer of the cervix, and Argentine doctors treated her with radium, then a standard therapy.

After examining Eva for the first time in October, Pack flew back to what is now Memorial Sloan-Kettering Cancer Center in New York. On returning to Argentina in November, he performed extensive surgery because the cancer had spread to adjacent pelvic organs, and he stayed until Eva was stable.

At the time, the Argentine government declined to disclose the nature of Eva's illness. Press reports gave conflicting views as to whether she had cancer. Peron was re-elected while Eva recuperated from surgery. Later, she resumed limited political activities. But when the abdominal pain returned in February 1952, Argentine doctors confirmed, again without telling Eva, that the cancer had recurred with striking rapidity.

Although the cancer shrank temporarily with additional radiotherapy, the pain recurred in May 1952. Chemotherapy failed. Eva died on July 26, never knowing that she had cervical cancer, the same disease that had killed Juan Peron's first wife.

In lifting Eva's medical story from obscurity and reporting it in the June 3 issue of The Lancet, Dr. Barron Lerner, a medical historian and ethicist at Columbia University, has added new information to an earlier biography of Eva and a small number of articles about her illness in Argentine newspapers and medical journals.

Lerner stumbled upon Pack's role in the case while researching a book on the history of breast cancer. He pursued the Peron story because it was important to medical history and showed the radical change in medical practice and ethics over the past 50 years, he said in an interview.

In the last century, patients with cancer and other fatal conditions were rarely told what they had. Now, as paternalism has yielded to consumerism and truth-telling in medicine, most such patients in the United States are told of the diagnosis and who will do their surgery. Occasionally, the diagnosis is withheld because of cultural differences and language problems. Yet patients in some other countries are still not told.

Pack, who died in 1969, had wanted to write about his role in Eva's case, but he could not because he was bound to protect patient-doctor confidentiality. Pack did, however, leave records that his widow, Helen, allowed Lerner to report because of earlier disclosures about the case.

The records showed that Pack did not seek to become involved in the case and was not paid, and that Ellsworth Bunker, then the ambassador to Argentina, and other government figures approved of Pack's actions, Lerner said.

Many famous people receive less than optimal medical care as victims of the so-called VIP syndrome. In it, doctors deviate incorrectly from standard practice either for perceived personal gains of fame or out of demands from such patients.

"Some surgeons might have been tempted to try heroic measures like a salvage operation to try to extend her life, but Dr. Pack did not treat Evita like a VIP," Lerner said. "When Eva's cancer recurred, Dr. Pack declined to perform further surgery in the belief that it was futile."

It is not clear whether Eva's cervical cancer would have been detected earlier if she had been in the United States. The Pap smear, which can detect cervical cancer in its earliest stage, was developed in 1942, and in 1950 it still was not standard in medical care in the United States or Argentina.

The Argentine and U.S. governments apparently have not officially confirmed that Eva Peron had cervical cancer or that Pack performed the operation without her knowledge. State Department officials and the Argentine Embassy in Washington said they had no knowledge about Eva's case because it occurred so long ago. Lerner said he did not try to examine Eva's medical or government records.

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