Day 252 - 20 May 96 - Page 09


     
     1        finds what it was you have been referring to, does one not,
     2        a short piece by Plotnik and others.
     3        A.   Yes, it is, this is an abstract of a paper that was
     4        presented at a very large meeting.
     5
     6   Q.   American College of Cardiology meetings at Orlando,
     7        Florida, during May 1996, according to the writer of the
     8        letter?
     9        A.   Yes.
    10
    11   Q.   Have you given consideration to this abstract, or whatever
    12        it is, summary?
    13        A.   Yes, I have.
    14
    15   Q.   Can you tell us, please, what conclusion, if any, we may
    16        safely base upon it?
    17        A.   Well, yes, the first thing I would say about both of
    18        these papers is that they are short abstracts of
    19        communications at very large meetings.  They are not full
    20        papers.  They are not peer reviews.  They have not been
    21        published in reputable scientific journals.  That does not
    22        necessarily mean that a paper that they present at a
    23        scientific meeting is of no value, but the problem is so
    24        much information one would want to have is not there
    25        because of the shortness of the paper itself.  Now, having
    26        said that, which applies to both of the papers, I can
    27        comment on the paper from Professor Vogel and his
    28        colleagues.
    29
    30        The first point I would make is that this is a piece of
    31        work that had been done on 5 subjects, which is a very
    32        small number of people to study, and essentially what they
    33        were doing was feeding these people a breakfast which is an
    34        enormous breakfast.  This may be typical of Americans, but
    35        certainly it is not one I could face, an enormous breakfast
    36        which is high in fat, probably about four to five percent
    37        fat in that breakfast, compared with a breakfast which is
    38        virtually devoid of fat.  It is essentially carbohydrate
    39        with some protein.  Then they make a measurement of what
    40        they refer to as vasco activity.  I must admit that is an
    41        area with which I was not familiar, so I consulted a
    42        colleague in Kings College who is Director of the Vascular
    43        Biology Unit to explain to me exactly what was going on,
    44        and what is going on is that measurements were made not in
    45        a coronary artery but in the artery of the arm, the
    46        brachial artery, and the procedure is to measure by an
    47        indirect procedure, which is ultrasound, to measure the
    48        diameter of the brachial artery and then a cuff is put on
    49        the arm to completely cut off the blood supply as one
    50        experienced with blood pressure is measuring it.  That is 
    51        left on for 5 minutes, during which time the vessel expands 
    52        with the accumulation of blood and the maximum expansion, 
    53        according to the document here, is 20 percent.
    54
    55        Now, I would make the point that this is an extremely
    56        unphysiological thing to do, but it is apparently a
    57        measurement that cardiologists make.  Now, what they were
    58        doing was to measure the expandability of the blood vessel
    59        before a meal was given and then either a high fat or a
    60        fat-free meal was provided and this was followed up over a

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