Day 035 - 12 Oct 94 - Page 35


     
     1        A.  A strong body of evidence suggests that it does.
     2
     3   Q.   My Lord, I was going to pass on to Dr. Willett.
     4
     5   MR. JUSTICE BELL:  Can I just raise one matter there?  One of
     6        your criticisms of the Surgeon General's report -- since
     7        I have not read it all I do not know whether it is
     8        completely valid or not -- is that he does not add causal
     9        mechanisms into his consideration of the strength of the
    10        evidence.  That is an attempt to summarise a point which
    11        I think you have made more than once in your evidence.
    12        A.  He does bring in causal mechanisms to a degree, but
    13        not to the degree that we discussed them yesterday.  It is
    14        a  -----
    15
    16   Q.   Doll does do that, does he not, so far as breast cancer is
    17        concerned?  I think on the following page in the section
    18        headed "Sex hormone related cancers" he is obviously very
    19        fully aware of the possible relevance of oestrogen.  He
    20        canvasses some of the factors.  Obviously, he is writing
    21        an article -- a guest editorial rather than a book -- and
    22        we can see his conclusion at the end of that section.
    23        A.  Yes.
    24
    25   Q.   Would it be fair to say that someone like Doll has a
    26        comprehensive knowledge and awareness of really all the
    27        factors which have been mooted and can be expected to have
    28        taken them into account, and you might say not
    29        sufficiently, but taken them into account before he comes
    30        to any general statement of conclusion?
    31        A.  I cannot say that, my Lord.  I have the greatest
    32        respect for Dr. Doll's writing.  He is coming to this from
    33        an epidemiologic perspective rather than from a
    34        biochemical perspective, and what evidence he has weighed
    35        here is difficult to say.  He has only provided one
    36        reference and has made no reference to the articles
    37        I described yesterday.  So, it is difficult for me to say
    38        what evidence he had access to and what he had
    39        considered.
    40
    41        One of problems that we have in this area is that those
    42        individuals who are looking for epidemiologic associations
    43        often write in quite a different way from those who look
    44        simply biochemically.  So, it is not possible for me to
    45        say what evidence he was weighing.
    46
    47   MR. JUSTICE BELL:  Shall we break off there until 2 o'clock.
    48
    49                            (Short Adjournment)
    50                                                     2.00 p.m. 
    51 
    52   MR. RAMPTON:  Dr. Barnard, I would like to move forward a year 
    53        from 1988 and Sir Richard Doll to 1989 and Dr. Willett of
    54        Havard.  My Lord, this next reference is one of Professor
    55        Crawford's.  It is at line 25 of his list of references.
    56        It is an article in "Nature" headed "The Search for the
    57        causes of breast and colon cancer".  I do not know how the
    58        witness will acquire a copy of this but it is important he
    59        should.
    60

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