Day 253 - 21 May 96 - Page 33


     
     1        A.  Yes.
     2
     3   Q.   In this chart we seem to do worse than the Germans and the
     4        French; is that right?
     5        A.  It would seem so, yes.
     6
     7   Q.   We have a higher proportion of males between 36 and 64 who
     8        are regular smokers?
     9        A.  Yes.  To me this is surprising, but obviously it is an
    10        accurate report.  I always thought everybody in France
    11        smoked.
    12
    13   MR. JUSTICE BELL:  That is if you include ex-smokers is it?
    14
    15   MR. RAMPTON:  On the white we do worst than the Germans and the
    16        French.
    17
    18   MR. JUSTICE BELL:  Yes.
    19
    20   MR. RAMPTON:  We also do worse on other smokers, ex-smokers,
    21        whether it is better or worst, it is smaller and
    22        non-smokers we are slightly better than the French, worst
    23        than the Germans.  Professor Naismith, the last sentence of
    24        the text above those last tables 2.2.7, which begins
    25        "international Comparisons in Risk Factors", says this:
    26        "Though France has at least average levels of systolic
    27        blood pressure, plasma cholesterol and body mass index and
    28        smoking it has the lowest mortality for cardiovascular
    29        disease".  That is what we have been calling the French
    30        paradox, yes?
    31        A.  Yes.
    32
    33   Q.   We also, perhaps you would agree, notice from this there
    34        may also be a German paradox; do you agree with that?
    35        A.  There seems to be quite a number of paradoxes.
    36
    37   Q.   Indeed, there are, and one can look at these charts
    38        endlessly and dig out a whole lot more.  The question I
    39        have to ask you, as an expert nutritionist, having gathered
    40        all this material together -- and, as I say, one could go
    41        on making comparisons until the cows come home, I have not
    42        even looked at stroke, and its comparisons with heart
    43        disease -- what sensible conclusions can one safely draw
    44        from material like this about the role which diet has in
    45        relation to coronary heart disease, mortality and stroke
    46        mortality in these western industrial countries?
    47        A.  Well, what this diagram is looking at is the accepted
    48        risk factors for coronary heart disease.  These are the
    49        lower ones, and in the upper right-hand corner we are
    50        looking at individual components of the diet, some of which 
    51        are thought to be associated with the disease in a negative 
    52        way and others in a positive way.  Of course, all of that 
    53        together composes our diet.
    54
    55        I have certainly looked at this many times in the hope of
    56        discovering something that was consistent in making
    57        comparisons from one country to another, and just when
    58        I thought I have got it I suddenly found that there are
    59        exceptions all over the place.  I think what this is
    60        saying, really, is that one must consider diet and other

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