Day 252 - 20 May 96 - Page 29


     
     1   MS. STEEL:  I am sorry, I did not realise you did not have the
     2        letter.
     3        A.   I know have seen the letter.  I know what is in it.
     4
     5   MR. JUSTICE BELL:  Read the letter through to yourself first.
     6        A.  I have actually seen the letter.  I know what is in it.
     7
     8
     9   MR. JUSTICE BELL:   Just make any check you want to in order to
    10        answer Miss Steel's question.
    11        A.   I find it difficult, your Lordship, referring to this
    12        letter because this is not a scientific paper.  This is a
    13        letter.  If it were a scientific paper I would have a great
    14        deal more to argue with it.  I mean, this would not be
    15        submitted to a scientific community as a cited paper.
    16        There are things in it which are quite wrong, in fact.
    17
    18   MR. JUSTICE BELL:   The way I read it, although it is at fasting
    19        level, although the levels there are fasting levels, which
    20        means they are not immediately after a meal, and if I just
    21        take the abstract itself, I would not have thought they
    22        were immediately after the oral fat load either.  The
    23        letter appears to say that they are after having the
    24        milkshake and therefore (f) for fasting must mean not after
    25        immediately after the meal but after drinking the
    26        milkshake.
    27
    28   MR. MORRIS:  Yes.
    29
    30   MR. JUSTICE BELL:  Although I must say the milkshake would seem
    31        to be a decent meal for a lot of people on its own, to have
    32        that much fat in it?
    33        A.   These are, in fact, fasting blood levels.  In a
    34        procedure in a test of this kind the subject would come in
    35        first thing in the morning in a fasting state and you
    36        measure baseline values.  These are the values on which all
    37        the data in the COMA report is based.  They are on fasting
    38        level, that is are measured first thing in the morning, and
    39        they indicate what the persistent value is in response to a
    40        particularly dietary treatment.  The dietary treatment was
    41        either a high fat diet, 40 per cent, or a low fat diet, 30
    42        per cent.
    43
    44   MR. JUSTICE BELL:   I appreciate that, but there would not seem
    45        to be much point in introducing the oral fat load,
    46        administering the oral fat load, unless it was going to be
    47        after that that one took the blood samples; do you see?  We
    48        might just as well miss that out altogether?
    49        A.   I agree, your Lordship, it would have been much better
    50        if the table had referred to the response to the fat load 
    51        rather than the baseline values.  The information about the 
    52        response to the fat load is underneath where it tells us 
    53        that one fraction of the triglycerides remains at a
    54        persistently higher level following the high fat meal than
    55        it did after following the low fat meal, and that is the
    56        basis of the significant difference that they quote.  So,
    57        the meat of the matter is confined to statements with
    58        numbers that come underneath the table rather than the
    59        table itself.
    60

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