Day 254 - 22 May 96 - Page 12


     
     1        is not something which has happened this year or last year,
     2        or over a 2-year period; it is something which has gathered
     3        as time has gone past.
     4
     5   Q.   So, basically, it has been going on ever since the very
     6        first studies were done in the 1960s and 1970s?
     7        A.  I would say so.
     8
     9   Q.   Right, but despite that, as we heard the last time you were
    10        here, the World Health Organisation, the US Government, and
    11        numerous other authoritative bodies on the issue of diet
    12        and chronic diseases have felt that there is enough
    13        evidence to make recommendations that people modify their
    14        diet to prevent these diseases?
    15        A.  The relationship between diet and disease, in general,
    16        is complex, and I have already said to you that one of the
    17        things that we know, as far as cancer patients is
    18        concerned, is that obesity appears to carry a bad omen as
    19        far as the outlook following treatment, so it is only
    20        reasonable to try to give people advice which will stop
    21        them getting into the situation where they are rendering
    22        themselves more prone to adverse circumstances, such as
    23        trying to avoid becoming obese.
    24
    25        What you are doing, in some respects, I am afraid, is
    26        taking that quotation out of context because this case, as
    27        I understand it, is based on the relationship between diet
    28        and breast cancer, and large bowel cancer, but we do know
    29        that in relationships to other forms of cancer, like cancer
    30        of the mouth and cancer of the oesophagus there are more
    31        clear cut relationships between elements in our diet, such
    32        as alcohol, for example.
    33
    34        This blanket recommendation that you suggested has been
    35        made is to try to give people general advice about the way
    36        they should lead their lives to try to reduce the
    37        likelihood of them getting chronic disease.  It is not
    38        specifically related to cancer of the breast and cancer of
    39        the bowel.
    40
    41   Q.   The recommendations were to reduce fat consumption, in
    42        particular saturated fat consumption, to increase fruit and
    43        vegetables and fibre intake and so on?
    44        A.  Right.  If you are a body trying to give
    45        recommendations to people, I have already said this to you,
    46        that I am faced with the problem of actually trying to give
    47        patients recommendations about what they should or should
    48        not do, I have already said that in the 1960s and 1970s, it
    49        appeared there was a very clear cut relationship between
    50        fat and breast and bowel cancer incidence. 
    51 
    52        Now, in the current situation there is no clear 
    53        relationship, but it has been stated in the past that fat
    54        may be related to the development of these cancers.  It
    55        will be foolish of me to say to patients: "Eat a lots and
    56        of fat" because, apart from the possibility that fat may
    57        have some part to play, what I am saying is we do not know
    58        the answer to that as far as these two particular cancers
    59        is concerned, but that it does have a greater propensity to
    60        make people obese because the amount of calories per gram

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