Day 036 - 13 Oct 94 - Page 45


     
     1
     2   MR. MORRIS:  He needed some kind of official letter or document
     3        or something so that he can show to the airline company to
     4        say why he has been delayed, then he will not have to pay
     5        extra money.
     6
     7   MR. JUSTICE BELL:  Tell me what letter you need.  (Discussion
     8        concerning flight details)
     9
    10                            (Short Adjournment)
    11
    12                       Re-Examined by the Defendants
    13
    14   MR. MORRIS:  First of all, a question about methodology in
    15        epidemiological studies.  We looked at one study which you
    16        may recall -- I do not think you need to get hold of it
    17        now -- which was the Yvonne Jones' study, Dietary Fat and
    18        Breast Cancer and the National Health and Nutrition
    19        Examination Survey?
    20        A.  Yes.
    21
    22   Q.   Is it "she"?
    23        A.  Yes, "she".
    24
    25   Q.   She talked about -- Mr. Rampton read them out -- certain
    26        standard breast cancer risk factors which, unless I am
    27        contradicted, included -- sorry:  "The standard breast
    28        cancer risk factors generally showed the expected
    29        associations".  This was page 502 of the Arnott bundle.
    30        It talked about the upper quartile of fatness, also showed
    31        a significant elevation in risk, and older age at
    32        menopause increased risk.  Later on it says older age at
    33        menarche increased risk.
    34
    35        I do not know in this particular survey, unless we go into
    36        it in depth (which I do not want to again), but when there
    37        are risk factors which may compound a survey that is
    38        focusing just on one thing such as purely, maybe, the
    39        linear relationship of fat and breast cancer, are those
    40        risk factors generally removed from the assessment of the
    41        results?
    42        A.  Typically, one would do assessments both with and
    43        without controlling for the risk factors, so, yes, one
    44        would try to do that, although to the extent that that is
    45        possible.
    46
    47   Q.   I seriously do not know the answer, that is why I am
    48        asking.  If a study concluded, for example, that they
    49        could not find a correlation between fat and breast
    50        cancer, is it possible they may have removed some of the 
    51        risk factors that could have fat implications, those 
    52        I have mentioned, and that actually may weaken the ----- 
    53        A.  Yes.  Forgive me.  I interrupted you.
    54
    55   Q.   You explain.
    56        A.  If, for example, one recognises that obesity is a risk
    57        factor for breast cancer and if one controls for obesity,
    58        by that I mean tries to remove the effect of obesity, that
    59        may inadvertently appear to remove the effect of, say, a
    60        high-fat diet because those people who are obese may,

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