Day 266 - 20 Jun 96 - Page 34


     
     1   Q.   So, you see, it is something of a randomised trial?
     2        A.  Yes.
     3
     4   Q.   You will see that the criteria which they used for the
     5        selection of those trials which are 46 -- sorry, 56 -- in
     6        all were quite strict?
     7        A.   Yes.
     8
     9   Q.   And you see the conclusion.  I will read it, at the bottom
    10        of the first column on the first page:
    11
    12        "Dietary sodium restriction for older, hypotensive
    13        individuals might be considered but the evidence in the
    14        normotensive population does not support current
    15        recommendations for universal dietary sodium
    16        restriction."
    17
    18             You see that.  I am not asking you to express an
    19        opinion about the methods or the data described in the
    20        articles.  That would not be fair.  What I do ask you is
    21        this:  suppose that to be right, would you agree with me
    22        that one must, because of pieces of research like this, be
    23        very cautious about being over dogmatic about the role of
    24        salt in diet and in relation to health?
    25        A.   I think if you look at the paper in the context of the
    26        way papers are produced, that there is an overwhelming
    27        consensus on salt and the benefits of salt reduction, even
    28        from this Government, although Governments do tend to be
    29        very cautious when making recommendations like that.  Even
    30        this Government would recommend that -- I think, they do
    31        not want us to increase the amount of salt and ways should
    32        be found, if you look at the actual Government literature
    33        that is produced, ways should be found to reduce salt.
    34        That is very cautious there.  In any sort of health debate
    35        you are always going to find a mixture of papers, because
    36        it is a very complex thing, trying to isolate a particular
    37        dietary factor and say, you know, because you cannot
    38        experiment on groups of populations, you have to put them
    39        in unnatural situations.  So it is very hard to get that
    40        result.
    41
    42             This particular paper that was presented to me seems
    43        to be against all the, if you like, consensus opinion of
    44        people who have been reading these papers for a living.  It
    45        seems to be, if you like, a rather road paper in the sense
    46        that the conclusions it comes to are quite different from
    47        the conclusions of many other papers which suggest a
    48        reduction in salt.  Also, I mean, it is looking at lots and
    49        lots of different trials and there are all sorts of ways of
    50        coming up with, you know, different ways of analysing
    51        things, and I would be very cautious about looking at this
    52        particular paper as sort of like the be all and end all in 
    53        terms of advice.
    54
    55   Q.   No, again, I am afraid I am, perhaps, not on the same wave
    56        length as you.  You come to a point in your professional
    57        career where a state of affairs, so far as you can see,
    58        appears to represent a consensus.  Yes?  Something appears,
    59        and this is a meta analysis which I think you mentioned
    60        earlier as being a particularly valuable source of

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