Day 266 - 20 Jun 96 - Page 21


     
     1        Journal of the American Medical Association.  I would have
     2        given it to the defendants before Court but they were not
     3        in the usual place and I did not search the building for
     4        them, I am afraid.  I would want to ask maybe one question
     5        about this.  I would be entitled to, given the evidence
     6        in-chief that we have had, after the lunchtime
     7        adjournment.  So perhaps I could dish out copies.  Miss
     8        Brophy would, I expect, be very familiar with it.  It has
     9        just been published end of May '96.
    10
    11   MS STEEL:  If I could just make a comment on that?  When I
    12        actually handed over the BMJ paper the other day I did say
    13        Miss Brophy would be referring to it, and when we raised it
    14        in Court yesterday we again said Miss Brophy would be
    15        referring to it.  We deliberately have not gone through the
    16        parts that would be related to the admission, and I only
    17        brought it in for the figures about what the degree of the
    18        risk was.  So, I do not think that, given their admission,
    19        the Plaintiffs should be able to start casting doubt on
    20        whether or not there is any evidence that there is a causal
    21        link.
    22
    23   MR. RAMPTON:  No.
    24
    25   MR. JUSTICE BELL:  What I am interested in the salt element -- I
    26        will explain and then I will suggest what we do and rise --
    27        is because of the meaning as I have defined it, quite apart
    28        from the dispute about the extent to which eating any or
    29        such and such an amount of McDonald's food might affect
    30        your diet, I may well have to grapple with -- well, I will
    31        have to grapple with -- the extent of any risk.
    32
    33   MR. RAMPTON:  My Lord, that is right.
    34
    35   MR. JUSTICE BELL:   Should McDonald's food so affect diet by
    36        making it high in fat and salt and lower in fibre or
    37        helping sustain a diet which has those characteristics, and
    38        what I may -- I am putting in it very neutral terms -- what
    39        I may very well have to do is grapple with what the risk is
    40        and it may be particularly important because it may be that
    41        one's got to keep one's eye on the possible distinction
    42        between, for instance, views that you can minimise risk by
    43        following a certain diet on the one hand and any evidence
    44        which I may have that if you do not follow such a "healthy"
    45         diet you will actually create a very real risk of
    46        suffering a particular degenerative disease, and I think I
    47        must keep that distinction in mind.
    48
    49             If there is such a distinction then it is important to
    50        know what the evidence is, not just that lowering salt
    51        intake may lower blood pressure and may lower incidence of
    52        ischemic heart disease, query whether stroke comes in, but 
    53        also know to what extent it does that.
    54
    55             This is not a point made against you.  It is just
    56        underlining what I particularly have in mind, and that is
    57        partly why I asked the question, which report was it that
    58        Mrs. Brophy found significant?  Was it the one which says a
    59        modest change, was it the part which showed, or purported
    60        to show, that such and such a lowering of salt intake led

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