Day 034 - 11 Oct 94 - Page 20


     
     1        my presumption is he is talking about a protective effect
     2        of fibre, since that is what he is saying in the words
     3        immediately preceding that sentence:  "Various
     4        investigators observed a protective effect of fibre
     5        containing foods, especially vegetables".  So, I presume
     6        he is saying a protective effect has also been found in
     7        two case-control studies that examined the relative risk
     8        of high fat/low fibre diets.  But my presumption is that
     9        the Surgeon General is not intending to say that a high
    10        fat/low fibre diet is protective.
    11
    12   Q.   He may not be intending to show that.  I just wonder what
    13        we would have if we had that extra column.
    14        A.  My assumption of what he is -----
    15
    16   Q.   He goes on to say:  "Overall case-control studies present
    17        mixed results; some show fibre and fibre-containing foods
    18        to be protective; others do not".  You may or may not
    19        agree with his comments, but that is what he is saying, is
    20        it not?
    21        A.  No, I do agree with that comment.  If he had said
    22        after that sentence that, in fact, some studies show that
    23        a high fat/low fibre diet is protective, then I would
    24        suggest that he might be saying that Dales' and Manousos'
    25        studies had shown that a high fat/low fibre diet was
    26        somewhat protective.  I do not think that is what that is
    27        showing.
    28
    29   Q.   Are Dales and Manousos amongst our documentation?
    30        A.  Not to my knowledge.
    31
    32   MR. MORRIS:  I do not have the book in front of me so I am at a
    33        bit of a disadvantage.
    34
    35   MR. JUSTICE BELL:  I think you should ----
    36
    37   MR. MORRIS:  Is it possible that it refers to the fact that if
    38        you have a high fat/low fibre diet, the fibre you do have
    39        in your diet is still protective?
    40        A.  I would presume that is what he is saying, because
    41        when we look at how Dales' study is characterised,
    42        increasing fibre and going lower in fat was protective
    43        indicated by the negative in the fourth column there.
    44        Manousos' study was also protective for vegetables.
    45        I would be very surprised if he was trying to suggest that
    46        going high fat and low fibre exerted some protective
    47        effect, particularly since it was not in his summary
    48        statement.
    49
    50   MR. JUSTICE BELL:  I have to say I find that construction 
    51        difficult on the wording which is on that page; whether 
    52        the wording which is on that page actually reflects what 
    53        the papers say, of course, is another matter.
    54        A.  Yes.  If it would be helpful, I would be more than
    55        happy to get my hands on those studies.
    56
    57   MR. JUSTICE BELL:  Leave that on one side.
    58
    59   MR. MORRIS:  Are we finished with that chapter?  Mr. Rampton
    60        might want to come back on it.

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