Day 035 - 12 Oct 94 - Page 26


     
     1   MR. RAMPTON:  Can we please look, despite your, shall I say,
     2        strictures on his impartiality (by implication at least),
     3        what it was that the Surgeon General's report said, so far
     4        as the implications for public health are concerned, in
     5        his 1988 Report, page 224?  Do you have it?
     6        A.  Yes.  Would you like me to read a portion of that
     7        page?
     8
     9   MR. JUSTICE BELL:  No.  Find the page and then Mr. Rampton will
    10        move on.
    11
    12   THE WITNESS:  Yes, I am with you.
    13
    14   MR. RAMPTON:  Page 224, and I will read to the top of page
    15        226:  "Implications for Public Health Policy, Dietary
    16        Guidance, General Public.  The dietary factors evaluated
    17        for the possible relationship to cancer risk are fat,
    18        calories, fibre, foods high in vitamin A and carotenoids,
    19        and alcohol.  Roles for vitamin C, vitamin E, selenium,
    20        protein, and salt-cured, salt-pickled, and smoked foods
    21        have been proposed.
    22
    23        Studies of carcinogen-induced tumorigenesis in
    24        experimental animals and international epidemiologic
    25        comparisons have provided substantial but not conclusive
    26        evidence that dietary fat increases the risk for cancers
    27        of the breast, colon, rectum, endometrium, and prostate.
    28        The results of epidemiologic investigations within more
    29        homogeneous population groups, however, are inconsistent.
    30        Because fat contains more than twice the calories per
    31        given quantity of protein or carbohydrate, high-fat diets
    32        are generally high in calories.  Despite such
    33        complications, the animal and international epidemiologic
    34        data suggest that a decrease in fat consumption by the
    35        general public from the current 37 percent of total
    36        caloric intake might reduce the risk for certain cancers."
    37
    38        Dr. Barnard, do you propose that those words, that form of
    39        words for dietary guidance to the general public in
    40        relation to cancer risk are unduly cautious in 1988?
    41        A.  That paragraph is reasonable.  However, it does not go
    42        to the full range of evidence that shows a causal nature.
    43        What Dr. Koop is writing of here is limited only to
    44        international epidemiologic comparisons, as I read it, and
    45        experimental animal studies and does not go to the
    46        evidence that was provided in great detail yesterday
    47        establishing the mechanisms that actually do link high-fat
    48        diets with certain forms of cancer.
    49
    50   Q.   Do or might, Dr. Barnard? 
    51        A.  I am saying "do". 
    52 
    53   Q.   I know that you are.  He canvasses international
    54        epidemiology as well as, what one might call, domestic
    55        epidemiology, does he not?  That is to say, I assume, both
    56        case-control and cohort studies, is that right?  "The
    57        results of epidemiologic investigations within more
    58        homogeneous populations groups are inconsistent".  That is
    59        what he is referring to?
    60        A.  Yes, presumably.

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