Day 256 - 04 Jun 96 - Page 59


     
     1        A.  Yes, I say that there is a general consensus of
     2        opinion.  The strength of the association has been debated
     3        quite vigorously.
     4
     5   Q.   Yes.  Association is one thing.  As we noticed before,
     6        there is an association between telegraph poles and heart
     7        disease, whatever it was.  Causation of is quite another
     8        thing; do you agree?
     9        A.  Yes.
    10
    11   MR. JUSTICE BELL:  I would like to ask a question, Mr. Rampton,
    12        while it is on my mind.
    13
    14        Are you saying that that is actually the intake of fat
    15        itself, or might it be, even for someone who holds your
    16        general view of the topic, that if you get less of your
    17        energy from fat, and particularly if you get less of your
    18        total energy from animal fat, you are likely, if you are
    19        not to be short of calories altogether, to eat far more
    20        vegetable matter and complicated carbohydrates, and so on,
    21        which you would say (and others would say) may very well
    22        have a protective element in them, and in China, in
    23        particular, may have an extra protective effect because of
    24        the particular kinds of vegetables, fibre, whatever, which
    25        they have in their diet and which we would not, even if we
    26        were vegetarian or vegan in this country, have in ours,
    27        because we would be eating different vegetables?  It is a
    28        rather long question, but do you understand what I am
    29        putting to you?  In other words, do you say it is actual
    30        fat which has the causative effect, or is it a remove from
    31        that:  if you eat less fat, particularly if you eat less
    32        animal fat, you eat more vegetables, you get more of your
    33        energy from complicated carbohydrates, and that has a
    34        protective effect?
    35        A.  Yes, I agree with everything you said.  I think you put
    36        it quite well.
    37
    38   Q.   Is that what you are -- I will say it again, because
    39        I thought I was putting an alternative view for you to
    40        choose.  Are you saying that ingestion of fat, and
    41        particularly ingestion of animal fat, has a causative
    42        effect on its own, or are you saying that it has an
    43        indirect causative effect, in that if you eat a lot of
    44        animal fat you are going to eat less vegetable matter and
    45        fibre and, therefore, there is a less protective effect?
    46        A.  Both.  I have used the term "aggregate" on a number of
    47        occasions, and that is what I mean by that term; that, in
    48        addition to the enhancement of cancer risk by dietary fat
    49        alone, we also see all of these other things tended to
    50        operate at the same time.  So, as we look across, let us 
    51        say, many cultures, with widely varying fat intakes, and we 
    52        see this very strong and impressive association between 
    53        dietary fat intake and breast cancer, for example, or colon
    54        cancer, we have to take into consideration what you just
    55        said, namely, that there is a contribution of fat itself;
    56        in some cases it is purely modest, if you will, and in some
    57        kind of cases it may be more substantial, but it is also a
    58        contribution to an increase in cancer risk in any case; and
    59        at the same time, in all these other things that are being
    60        displaced by the consumption of fat, are surely

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