Day 036 - 13 Oct 94 - Page 33


     
     1   MR. JUSTICE BELL:  Sorry to interrupt you.  I have the point
     2        you have made in relation to that.  I would like to know
     3        if Mr. Rampton is right in what he is putting or not
     4        right.  You have expressed your view very clearly and, if
     5        I may say so, your various reasons for it.  Now
     6        Mr. Rampton is looking at the whole body of other
     7        reputable scientific opinions.  If you put the question
     8        again, Mr. Rampton:  You have not succeeded in showing us
     9         -- this is a question -- Mr. Rampton does not know of any
    10        authority certainly in the last 8 or 10 years that has
    11        felt able to assert, whether a public authority or a
    12        professional scientist, with any confidence that these
    13        assertions we have been discussing are, indeed, causal?
    14        A.  Forgive me for trying to be very specific in my
    15        response.  The links we are discussing are causal in
    16        nature.  What is in doubt is how much confidence, how much
    17        definitiveness can be given to them.  No one is
    18        suggesting, for example, that breast cancer causes a
    19        high-fat intake.  What has been investigated over and over
    20        again is the causal link that a high-fat diet may cause
    21        breast cancer.  That is what is being discussed.  But you
    22        are quite right, that no one has been able to say with any
    23        confidence that, indeed, the link is quite certain to be
    24        causal except in so far as those links are under
    25        investigation, presumed to be causal or quite probably are
    26        causal.
    27
    28   MR. RAMPTON:  Can we put away Dr. Willett?  My Lord, there is a
    29        lot more in there but I can leave it until the end of the
    30        case.
    31        A.  May I also add one other comment?  In that discussion
    32        we were simply talking about the rather bald epidemiologic
    33        studies.  We were not talking about any mechanistic
    34        studies whatsoever, because I think it would be a mistake
    35        to overlook the fact that a high-fat diet, as we have
    36        described but seems to get forgotten when we talk about
    37        epidemiology alone, is the fact that a high-fat/low-fibre
    38        diet or a diet that is high-in-fat and sugar and
    39        low-in-fibre does increase the risk of obesity.  If may
    40        say so, that is clearly a causal relationship, in that
    41        there are many, many experts who would, in fact, support
    42        that with a great deal of confidence.
    43
    44        In addition, there are many experts, perhaps an
    45        overwhelming number of experts, who would also hold that
    46        the links between obesity and breast cancer are clear and
    47        are causal.  So, when one is talking about which experts
    48        can assert what with confidence we have to be very, very
    49        careful.  It is dangerous to focus simply on overall
    50        epidemiologic studies, particularly those on very 
    51        restrictive populations. 
    52 
    53   MR. JUSTICE BELL:  I do not think Mr. Rampton was doing that.
    54        He was asking you for any respectable expression of
    55        scientific opinion or government body committee which says
    56        not "may" not "hypothesis", not "suggest", which says that
    57        a diet high-in-fat, saturated fat, etc. ----
    58        A.  Yes.  In so far as -- forgive me, I did not mean to
    59        interrupt.
    60

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