Day 035 - 12 Oct 94 - Page 38


     
     1        A.  For example, I attended a conference where he was in
     2        quite sharp disagreement with the National Cancer
     3        Institutes, Head of Cancer Prevention and Control.
     4
     5   Q.   In what sense?
     6        A.  Dr. Willett, although he has provided evidence that
     7        dietary factors are linked with breast cancer, his
     8        contention or, at least on the basis of his research, as
     9        I recall it at the time, was that the focus had to do more
    10        with vitamins and minerals so far as was known.
    11
    12        He was discounting the link with fat in breast cancer,
    13        while the opinion expressed by Peter Greenwald, who was
    14        (and is) the Director of Cancer Prevention and Control of
    15        the National Cancer Institute, was that while minerals and
    16        vitamins certainly are important, and Dr. Greenwald's
    17        writing on that subject is very, very well known,
    18        Dr. Greenwald also felt that the evidence on fat was quite
    19        important.
    20
    21   Q.   Yes, I entirely accept that.  We have seen and we have
    22        some of Dr. Greenwald's writings on the subject.  There is
    23        one, for example, in Dr. Arnott's references and it is
    24        true to say that Dr. Greenwald takes a somewhat position
    25        in relation to fat and breast cancer than Dr. Willett
    26        does.  What I am concerned to know from you, Dr. Barnard,
    27        is whether you regard Dr. Willett as so cranky or
    28        controversial that we should disregard what he says on
    29        these matters?
    30        A.  Some people do in the United States, but I do like to
    31        read what he has to say, I think.
    32
    33   Q.   Perhaps we should have a look at it.  It is right to say,
    34        is it not, that his overall view is that there really is
    35        not any causal connection to be acknowledged in relation
    36        to diet and breast cancer, but that the evidence is much
    37        stronger in relation to colon cancer?
    38        A.  No, that is not an accurate statement of what I have
    39        understood Dr. Willett's writing to say, no.
    40
    41   Q.   We had better look at this Review Article of, I repeat,
    42        March 1989.  May we just look, first of all, at the
    43        beginning of it?  I will not read the first -- perhaps
    44        I will read the first paragraph:  "Among non-smokers,
    45        cancers of the breast and colon are the most important
    46        malignancies in Western societies.  By the age of 75
    47        years, over eight per cent of women in the United States
    48        will develop breast cancer and about three per cent of
    49        both sexes will be diagnosed as having colon cancer.
    50        Another one to two per cent of men and women will develop 
    51        rectal cancer by the time they are 75; although this is 
    52        sometimes not distinguished from colon cancer, it will not 
    53        be considered here because", it has been obliterated in my
    54        copy, "some of its epidemiological features are distinct.
    55        Treatment of breast and colon cancer remains
    56        disappointing.  Hence, considerable interest has focused
    57        on determining the causes of these cancers, with the hope
    58        that such knowledge will lead to practical means of
    59        prevention.
    60

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