Day 017 - 25 Jul 94 - Page 54


     
     1        than that?
              A.  I think one cannot go further than that.  In the
     2        United States low dose asprin is a very popular therapy,
              mainly from the point of view of preventing coronary
     3        artery disease, because there is a very good correlation
              between reduction in risk of coronary artery disease and
     4        taking of low doses of asprin.  I suspect that in this
              survey, which looked at a whole population of people,
     5        there were a significant number taking asprin not from the
              point of view of large bowel cancer, but probably almost
     6        certainly from the point of view of coronary artery
              disease prevention.  This has been thrown up by this
     7        particular study, but exactly what the mechanism is
              I would not know.
     8
         Q.   Could one propose an independent role for asprin in the
     9        sense it might be protective in even in the absence of
              high fibre intake?
    10        A.  It might be.
 
    11   Q.   Or might it be hat the combination of the two is
              necessary?
    12        A.  Again it might be.  I would not like to say any more
              than that to be honest.
    13
         Q.   Then finally on this topic can we turn to a paper this
    14        time which is led by Dr. Wynder at tab 21, again from 1992
              I believe.  It comes from something called Cancer
    15        Supplement of September 1992.  This I take it is also an
              American publication?
    16        A.  It is.  This was originally presented at a conference
              and has then subsequently been written up for publication.
    17
         Q.   Much of the material we have looked at before is contained
    18        in this paper, so I am not going to go through the whole
              of it.  It is headed: Environmental Dietary Factors of
    19        Colorectal Cancer - Some Unresolved Issues" this is
              September 1992.  "Background: Unresolved epidemiologic
    20        issues in large bowel cancer include reasons for changes
              in incidence rates, differences in epidemiology of cancer
    21        in the distil and proximal colon."  What are the distil
              and proximal colon?
    22        A.  What they are meaning there is the right side or
              ascending colon and the descending colon.
    23
         Q.   Proximal is the one nearest to the right?
    24        A.  No.  Proximal is nearest to the small bowel.  Distil
              nearest to the rectum.
    25
         MR. JUSTICE BELL:  Nearest to the middle of the body, is it? 
    26        A. No. When I talked this morning about the small bowel 
              emptying into the large bowel, that is what they call the 
    27        proximal colon. It is the first part of the ascending
              colon. The distil colon is really the last bit of the
    28        descending colon before it becomes the rectum.
 
    29   MR. RAMPTON:  Proximal indicates proximity to the small colon?
              A.  Yes.  It is not a term that I would -----
    30
         Q.   It is not British medical-ease?

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