Day 036 - 13 Oct 94 - Page 52


     
     1        elucidating the causative role of fat being the causative
     2        agent along with other dietary factors and cancer being
     3        the result.
     4
     5   MR. MORRIS:  What does Willett say in that, in your
     6        understanding or interpretation, that that seemed to be
     7        the general view and he was somehow questioning the
     8        general view?  Is that the context in which his study
     9        takes place or his review takes place?
    10        A.  Willett seems to be acknowledging in this statement
    11        (and certainly in his other writings) that there is a
    12        substantial amount of evidence that indicates that a diet
    13        high-in-fat and low-in-fibre does contribute to the cause
    14        of cancer of the breast and colon, and he then elaborates
    15        on that from there.
    16
    17   Q.   The Surgeon General's report -- it was mentioned but
    18        I want to ask you again -- on page 194 of the Surgeon
    19        General's report; I think it may be useful to the court to
    20        go to that page.  194 in the Surgeon General's report,
    21        that is from chapter 4 on cancer.  I do not know again
    22        where that was put.
    23
    24   MR. JUSTICE BELL:  No, it is No. 7.
    25
    26   MR. MORRIS:  I think, though, Mr. Rampton had copied the whole
    27        chapter and it was not necessarily put in the same place.
    28
    29   MR. JUSTICE BELL:  It is behind Mr. Barnard's supplementary
    30        statement as No. 7.
    31
    32   MR. MORRIS:  The first line on the Role of Dietary Fats in
    33        Cancer, and this is in 1989, the Surgeon General's Report?
    34        A.  1988 actually.
    35
    36   Q.   Sorry, 1988, it starts off:  "Despite some
    37        inconsistencies", my emphasis, "in the data relating
    38        dietary fat to cancer causation, animal studies show an
    39        effect on carcinogenesis and support a cancer-promoting
    40        role, and international epidemiologic studies have
    41        suggested that differences in dietary fat intake may
    42        provide a meaningful key to prevention of cancer".
    43
    44        It goes on but I just I want to go back to the first
    45        phrase, "Despite some inconsistencies in the data relating
    46        dietary fat to cancer causation", how do you interpret
    47        that sentence?
    48        A.  A few things, perhaps, call for some attention; the
    49        first is that in any area of medicine when one reviews the
    50        research, there will always be inconsistencies in the 
    51        data.  That has been true for things, as clearly accepted 
    52        now, that we talked about, cigarettes and lung cancer. 
    53        So, there are inconsistencies; those have to be expected.
    54
    55        But Dr. Koop does use language that speaks of causation
    56        I guess in three parts of that sentence; the first is in
    57        the second line, "animal studies show an effect on
    58        carcinogenesis" which has to do with the beginnings of
    59        cancer causal.  The second line, "and support a
    60        cancer-promoting role", again related to causation as we

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