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.
