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
