Day 254 - 22 May 96 - Page 36
1 MS. STEEL: (To the witness): Would you agree that do you know
2 anything about blood elements being made sticky, to use a
3 not very technical term, by a diet high in saturated fat?
4 You do not know anything about that?
5 A. No. Well, I do, but I am not an expert in the field.
6
7 MR. JUSTICE BELL: As I understand it, the message I am rather
8 getting from you is you do know something about these
9 things but you feel rather inhibited as an expert in the
10 witness box in purporting to give an expert view. Is that
11 a fair assessment?
12 A. That is correct, my Lord, yes.
13
14 MS. STEEL: So are you really saying you cannot really comment
15 on Professor Crawford's hypothesis as an expert?
16 A. No. I think my understanding of Professor Crawford's
17 statement was that he suggested that a similar process
18 might exist to allow tumour cells to become lodged on the
19 wall of the blood vessel and, therefore, be able to gain
20 entry into the system and form a secondary deposit in the
21 same way that we know that when you have fat deposits
22 within the walls of blood vessels, it is more likely that
23 platelets will be adherent there and form a thrombosis.
24
25 What I am saying is that we do not have evidence
26 scientifically to support that concept. I am saying no
27 more than that. Because the two sites in the body where
28 you most commonly see secondaries, which is in the liver
29 and in the lungs, they do obviously go to other places such
30 as the bones and so on, but the commonest sites by far are
31 the liver and lungs, and these are blood vessels where you
32 never ever see atheroma or you get fat deposits within the
33 walls of the blood vessels except in the lungs in patients
34 who have high blood pressure within the pulmonary
35 circulation which is not a very common event. That would
36 not explain why metastases were able to form in certain
37 areas in the body which is the only point that I am making.
38
39 MR. JUSTICE BELL: Did you understand him where he referred to
40 the "endothelium being damaged" to meaning that it became
41 atheroma?
42 A. No, my Lord. What actually happens is that fat gets
43 deposited in the middle of the wall of the blood vessels,
44 and that then causes changes in the membrane which overlies
45 that part of the wall, and it becomes irregular and you may
46 get raw areas produced, and these, either because of the
47 secretion of certain chemicals or because the very fact
48 that they are raw, attract platelets to come to that point.
49
50 Q. But the bit in the middle is the atheroma; is it not?
51 A. Yes, it is.
52
53 Q. So they become, you say, fat deposits, atheroma which gives
54 the uneven surface on the lining. The atheroma is in the
55 ----
56 A. In the wall of the blood vessel.
57
58 Q. It is not, as a lot of people think, on the facing wall on
59 the inside of the blood vessel; it is between the two walls
60 of the blood vessel?
