Day 035 - 12 Oct 94 - Page 14


     
     1        form of words such as it has been postulated that, or it
     2        is believed that, or it may be that?  Do you understand?
     3        So do not answer now; just give it a bit of thought.
     4        A.  Yes, thank you.
     5
     6   MR. RAMPTON:  I will not waste the time of the court at the
     7        moment.  I should, however, like to be able to read the
     8        whole of that in due course.  My Lord, may we keep it on
     9        our side for the moment?
    10
    11   MR. JUSTICE BELL:  Yes, unless someone asks for it back.
    12
    13   MR. RAMPTON:  Can we look at page 6 in the column headed Causes
    14        and Prevention; do you have that?
    15        A.  Excuse me for one second, if I may, please?  Yes,
    16        page 6.
    17
    18   Q.   Page 6, the column headed Causes and Prevention?
    19        A.  Yes, I am with you.
    20
    21   Q.   "Scientists believe that cancers of the colon and rectum
    22        develop over a period of many years as the result of
    23        progressive changes in cells.  Although both hereditary
    24        and environmental factors appear to be involved, the
    25        causes of these changes are not well understood.  Doctors
    26        can seldom explain why a particular person develops
    27        colorectal cancer.  In most cases, the onset of the
    28        disease is probably triggered by complex interactions of
    29        several factors.  Among these are lifestyle and diet,
    30        heredity, sporadic polyps, inflammatory bowel diseases,
    31        and occupational exposure to carcinogens (cancer-causing
    32        substances)".
    33
    34        If you go over to the next page, page 7, you see halfway
    35        down the page, after a passage about Lifestyle, a passage
    36        headed Diet:  "Numerous animal experiments and population
    37        studies suggest that the development of colorectal cancer
    38        is linked to low intake of dietary fibre and that
    39        increased dietary fibre has a protective effect".
    40
    41        I am going to pause there, Dr. Barnard, if I may, to ask
    42        you two questions in the hope that I may not have to come
    43        back to the topic.  Do you accept that in relation to
    44        cancer of the colon, and possibly the rectum, the
    45        influence of diet is thought to be strongest in relation
    46        to the promotion as opposed to the initiation of cancers?
    47        A.  No, I do not accept that -- well, let me ask you to
    48        repeat the question before I give a response.
    49
    50   Q.   Do you accept that the role of diet is most strongly 
    51        suggested by the evidence in relation to colon cancer in 
    52        relation to promotion rather than initiation? 
    53        A.  Yes, I would agree with that, that there is a role for
    54        diet in both initiation and in promotion, but that the
    55        role in promotion is probably more decisive in the
    56        patient's clinical course, although the role of foods in
    57        initiation is also probably significant, particularly the
    58        carcinogens I mentioned earlier that can cause genetic or,
    59        presumably, can cause genetic changes in the bowel wall.
    60

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