Day 254 - 22 May 96 - Page 65


     
     1        appear from the vegetable and fruit side of things that the
     2        evidence, the consensus of evidence, is that it is
     3        protective.  What I am saying to you is that we cannot say
     4        that taking more fat than is recommended in this is
     5        necessarily harmful.
     6
     7   MR. MORRIS:  Apart from it is linked to obesity?
     8        A.  I think that is the argument that I would make, yes.
     9
    10   Q.   Just one point, the last line of that recommendation, or
    11        that conclusion, is that the point has probably already
    12        been reached for groups of people at high risk of cancer
    13        such as the first degree relatives of patients with cancer
    14        of the breast, colorectum or endometrium, that it is his
    15        view, is it not, that for people that are genetically at a
    16        higher risk of getting cancer it is even more important for
    17        them to take notice of these recommendations to improve
    18        their dietary habits?
    19        A.  Well, that is what he is saying and, of course, one
    20        ----
    21
    22   Q.   Do you agree with that?
    23        A.  One would have to agree with him in that there
    24        obviously is an increased risk which you know we believe
    25        may be genetic.
    26
    27   Q.   So the greater the genetic susceptibilities the greater the
    28        importance of diet for those people?
    29        A.  Well, I do not know that we even know that, to be
    30        honest with you.
    31
    32   MR. JUSTICE BELL: Is it more than this, that if you have a high
    33        risk to start with, that is bad enough, so anything you can
    34        do which avoids increasing the risk one iota becomes more
    35        important to you than to the man beside you who does not
    36        start with the high risk?
    37        A.  Yes, that is absolutely right.  That is my philosophy,
    38        yes.
    39
    40   Q.   It is not meant to be an absurd analogy.  If you are going
    41        to get on a motor bike and ride it, it is only sensible to
    42        put on a helmet.  It is not a very good analogy, but you
    43        put yourself at risk in the first place so it is more
    44        important to do absolutely anything you can to avoid
    45        increasing the risk at all?
    46        A.  Yes, I would say that is absolutely right.
    47
    48   Q.   Is Hill saying more than that when he speaks of the people
    49        at high risk, or is he saying there may be in there?  If
    50        they have a genetic propensity he is not saying that there 
    51        is some extra feature in fruit and vegetables? 
    52        A.  I think what he is saying, the benefit is tilted -- 
    53        sorry, the risk and benefit is tilted towards benefit.
    54        I think he is saying no more than that.  Again, as you
    55        rightly point out, my Lord, if one is at increased genetic
    56        susceptibility then one should be taking every opportunity,
    57        or trying every measure, to reduce one's risk as much as
    58        possible.  Now, I obviously deal with patients who are
    59        trying to do this all the time and many of the things which
    60        people will try are unproven, but certainly I never

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