Day 017 - 25 Jul 94 - Page 36


     
     1        Just so that we can see what those methodological problems
              are (or were) thought to be, please turn to page 469, the
     2        right-hand column underneath the table, where the authors
              write:  "It should be noted that the distribution of
     3        dietary fat intake examined in this analysis is heavily
              shifted toward relative high intakes.  Thus the disparity
     4        between these findings and cross-cultural studies may be
              because fat exerts an effect only up to a certain
     5        threshold level (eg. 15 or 25% of energy)."
 
     6        Do you know of any evidence which suggests whether or not
              there is a threshold in this sense?
     7        A.  No.  There is no knowledge whatsoever that there is a
              threshold effect.
     8
         Q.   "... which could not be addressed in this sample.  It may
     9        also be that dietary fat intake exerts its major influence
              early in life, such as during puberty, and an analysis of
    10        diets in adult women is not relevant.  In addition, the
              influence of any dietary changes that may have occurred
    11        after the baseline dietary assessment could not be
              determined in these analyses."
    12
              Is that a proper qualification of the findings of this
    13        study, so far as you are concerned?
              A.  Well, I think it is reasonable.  I mean, what they are
    14        saying is that the method of assessment of dietary intake
              is flawed; it is not perfect.  They are just raising the
    15        query that, you know, there are other effects which may
              have taken place which may have influenced dietary
    16        changes, for example.
 
    17        I just think that in a paper like this it is very
              reasonable people should put forward these
    18        qualifications.  This is what one would hope to see in
              most publications, that not only are they producing a
    19        result, but they are qualifying it by saying:  "Look,
              there may be some problems attached to this".
    20
         Q.   May I draw your attention to one final part of this paper
    21        which is the last paragraph on page, it must be 470.  It
              is the next page; it is the very last paragraph where the
    22        authors say this:  "This study is an important addition to
              the examination of diet and breast cancer because of its
    23        prospective nature in which careful dietary assessment was
              carried out prior to ascertainment of breast cancer
    24        status. The NHANES 1 survey that provided this cohort
              sampled from a large cross-section of the US population,
    25        and thus these data do not focus primarily on the
              upper-socioeconomic-class women at higher risk of breast 
    26        cancer who are usually the focus of breast cancer 
              studies". 
    27
              Dr. Arnott, was it the case in those days, 1987, perhaps
    28        it still is, that the women upon whom these studies
              focused were in the upper socioeconomic-classes?
    29        A.  There is a tendency for this because, of course,
              people in the upper socioeconomic-classes tend to be more
    30        interested in disease and in themselves and so on, often
              better educated and, therefore, they are more readily

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