Day 023 - 13 Sep 94 - Page 29


     
     1        heard:  "Dietary factors are now known to influence the
     2        development of a wide range of chronic diseases including
     3        cancer".  So what I am saying is that ---
     4        A.  They are obviously though -----
     5
     6   Q.   -- on the case-control area of evidence, we have heard
     7        that population studies and we have heard that animal data
     8        are pretty strongly backing the links, but that the area
     9        of case-control, I believe, in cohort studies is more
    10        controversial, but they seem to feel at this time in 1989,
    11        that case-control studies "provide stronger evidence to
    12        the effects of diet in relation to major cancers"?
    13        A.  But in the final page of Conclusions, of course, they
    14        are not just referring to one or two types of cancer.
    15        They are referring to all the cancers that they have
    16        studied.  They have actually made the point that they have
    17        included alcohol in the diet as well.  They are not just
    18        restricting themselves to breast cancer and colon cancer.
    19
    20   MR. MORRIS:  Right.  I think we have finished
    21        cross-examination.  Thank you.
    22
    23                        Re-examined by MR. RAMPTON
    24
    25   MR. RAMPTON:  Dr. Arnott, which particular document have you
    26        got in front of you because I will use that first?
    27        A.  Right.  This is the WHO 3.3.
    28
    29   Q.   Did you read the whole of section 3.3 while we were
    30        outside?
    31        A.  Yes, I did.
    32
    33   Q.   Did you notice whether the committee, or whatever this
    34        body is, made a distinction so far as causation is
    35        concerned between, for example, lung cancer and nicotine
    36        or tobacco and, for example, colorectal cancer and diet?
    37        A.  Yes, they did make a distinction.
    38
    39   Q.   Do you notice under 3.3.5 -- it starts at 3.3.4 on page 64
    40         -- the last sentence, they say this:  "On the basis of
    41        evidence in developed countries", this is on liver cancer
    42         "consumption of alcoholic beverages is causally related
    43        to liver cancer".   Did you see that?
    44        A.  I did.
    45
    46   Q.   As a statement of what one might call reputable medical
    47        opinion in 1989/90, would you agree or disagree with that
    48        statement?
    49        A.  I would agree.  The problem with all of this is that
    50        none of these relationships is just straightforward, but 
    51        certainly if you look at, for example, countries with a 
    52        high alcohol consumption, like France which has a higher 
    53        consumption than this country, there is an increased
    54        incidence of cirrhosis of the liver and liver cancer.
    55
    56   Q.   Do you notice at the top of page 67, 3.3.5:  "Lung
    57        cancer.  In most industrialised countries, lung cancer is
    58        the leading cause of cancer deaths among men, and it is
    59        rapidly approaching this status among women".  I think you
    60        told us something about that earlier this morning?

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