Day 035 - 12 Oct 94 - Page 30


     
     1        You are killing yourselves" if he believes it.
     2        A.  Could you repeat the question, part of that, please?
     3
     4   Q.   Yes.  If the Surgeon General thought that the typical
     5        American diet high-in-fat and low-in-fibre was killing
     6        large numbers of Americans annually, or even that there
     7        was a serious likelihood that it was, he would have a duty
     8        to say so, would he not?
     9        A.  Well, I cannot speak to what his duty may be.  It does
    10        seem to me, in reading the report, that he brings to the
    11        reader's attention there are substantial links and that
    12        these links are of a causal nature, but that there is some
    13        uncertainty remaining about that.  However, he is not
    14        simply talking about a random possibility.
    15
    16   Q.   Can we continue?  I will only read some other short
    17        passages from this to suggest to you, at any rate, what
    18        the Surgeon General in 1988 thought about some of the
    19        conclusions which you invited this court and the readers
    20        of your book to draw.
    21
    22        Starting at the top of page 225 in the first complete
    23        paragraph:  "Correlational epidemiologic studies suggest
    24        an association between diets low-in-fibre and increased
    25        risk for colon cancer, while results from case-control
    26        studies are mixed.  Studies in experimental animals
    27        indicate that further research is needed on the effects of
    28        different types of fibre.  While inconclusive, evidence
    29        suggests that an overall increase in intake of foods
    30        high-in-fibre might decrease the risk for colorectal
    31        cancer.  Despite the need for additional evidence, this
    32        recommendation is consistent with guidance for reducing
    33        gastrointestinal disease."
    34
    35        Again, the Surgeon General does not assert, as a matter of
    36        generally accepted scientific knowledge, that fibre has a
    37        protective or contributory role to play in relation to
    38        cancer, does he?
    39        A.  Would you like me to respond based solely on that
    40        paragraph or would you like me to refer to chapters in
    41        this book that relate to fibre?
    42
    43   Q.   What I am looking at is what the Surgeon General has,
    44        I take it, drawn together from the body of the report
    45        which are, as he calls them, Implications for Public
    46        Health Policy.  I will put the question again.  If you are
    47        right that all respectable or most respectable medical
    48        opinion in the mid-1980s believed that it was a fact that
    49        diet was a cause of these cancers, it is surprising, is it
    50        not, that the Surgeon General in 1988 did not say so? 
    51        A.  Well, first of all, I do not believe that is quite 
    52        exactly what I said.  What I said was that I believe that 
    53        by the mid-1980s links had been established, that these
    54        links were of a causal nature, and that they were accepted
    55        by the great majority of researchers.
    56
    57        What Dr. Koop is describing here are some overall studies
    58        and has not brought to the readers' attention much of the
    59        material that I was describing as being well accepted.
    60        For example, the fact, which Dr. Kinlen brought out in his

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