Day 035 - 12 Oct 94 - Page 35
1 A. A strong body of evidence suggests that it does.
2
3 Q. My Lord, I was going to pass on to Dr. Willett.
4
5 MR. JUSTICE BELL: Can I just raise one matter there? One of
6 your criticisms of the Surgeon General's report -- since
7 I have not read it all I do not know whether it is
8 completely valid or not -- is that he does not add causal
9 mechanisms into his consideration of the strength of the
10 evidence. That is an attempt to summarise a point which
11 I think you have made more than once in your evidence.
12 A. He does bring in causal mechanisms to a degree, but
13 not to the degree that we discussed them yesterday. It is
14 a -----
15
16 Q. Doll does do that, does he not, so far as breast cancer is
17 concerned? I think on the following page in the section
18 headed "Sex hormone related cancers" he is obviously very
19 fully aware of the possible relevance of oestrogen. He
20 canvasses some of the factors. Obviously, he is writing
21 an article -- a guest editorial rather than a book -- and
22 we can see his conclusion at the end of that section.
23 A. Yes.
24
25 Q. Would it be fair to say that someone like Doll has a
26 comprehensive knowledge and awareness of really all the
27 factors which have been mooted and can be expected to have
28 taken them into account, and you might say not
29 sufficiently, but taken them into account before he comes
30 to any general statement of conclusion?
31 A. I cannot say that, my Lord. I have the greatest
32 respect for Dr. Doll's writing. He is coming to this from
33 an epidemiologic perspective rather than from a
34 biochemical perspective, and what evidence he has weighed
35 here is difficult to say. He has only provided one
36 reference and has made no reference to the articles
37 I described yesterday. So, it is difficult for me to say
38 what evidence he had access to and what he had
39 considered.
40
41 One of problems that we have in this area is that those
42 individuals who are looking for epidemiologic associations
43 often write in quite a different way from those who look
44 simply biochemically. So, it is not possible for me to
45 say what evidence he was weighing.
46
47 MR. JUSTICE BELL: Shall we break off there until 2 o'clock.
48
49 (Short Adjournment)
50 2.00 p.m.
51
52 MR. RAMPTON: Dr. Barnard, I would like to move forward a year
53 from 1988 and Sir Richard Doll to 1989 and Dr. Willett of
54 Havard. My Lord, this next reference is one of Professor
55 Crawford's. It is at line 25 of his list of references.
56 It is an article in "Nature" headed "The Search for the
57 causes of breast and colon cancer". I do not know how the
58 witness will acquire a copy of this but it is important he
59 should.
60
