Day 035 - 12 Oct 94 - Page 30
1 You are killing yourselves" if he believes it.
2 A. Could you repeat the question, part of that, please?
3
4 Q. Yes. If the Surgeon General thought that the typical
5 American diet high-in-fat and low-in-fibre was killing
6 large numbers of Americans annually, or even that there
7 was a serious likelihood that it was, he would have a duty
8 to say so, would he not?
9 A. Well, I cannot speak to what his duty may be. It does
10 seem to me, in reading the report, that he brings to the
11 reader's attention there are substantial links and that
12 these links are of a causal nature, but that there is some
13 uncertainty remaining about that. However, he is not
14 simply talking about a random possibility.
15
16 Q. Can we continue? I will only read some other short
17 passages from this to suggest to you, at any rate, what
18 the Surgeon General in 1988 thought about some of the
19 conclusions which you invited this court and the readers
20 of your book to draw.
21
22 Starting at the top of page 225 in the first complete
23 paragraph: "Correlational epidemiologic studies suggest
24 an association between diets low-in-fibre and increased
25 risk for colon cancer, while results from case-control
26 studies are mixed. Studies in experimental animals
27 indicate that further research is needed on the effects of
28 different types of fibre. While inconclusive, evidence
29 suggests that an overall increase in intake of foods
30 high-in-fibre might decrease the risk for colorectal
31 cancer. Despite the need for additional evidence, this
32 recommendation is consistent with guidance for reducing
33 gastrointestinal disease."
34
35 Again, the Surgeon General does not assert, as a matter of
36 generally accepted scientific knowledge, that fibre has a
37 protective or contributory role to play in relation to
38 cancer, does he?
39 A. Would you like me to respond based solely on that
40 paragraph or would you like me to refer to chapters in
41 this book that relate to fibre?
42
43 Q. What I am looking at is what the Surgeon General has,
44 I take it, drawn together from the body of the report
45 which are, as he calls them, Implications for Public
46 Health Policy. I will put the question again. If you are
47 right that all respectable or most respectable medical
48 opinion in the mid-1980s believed that it was a fact that
49 diet was a cause of these cancers, it is surprising, is it
50 not, that the Surgeon General in 1988 did not say so?
51 A. Well, first of all, I do not believe that is quite
52 exactly what I said. What I said was that I believe that
53 by the mid-1980s links had been established, that these
54 links were of a causal nature, and that they were accepted
55 by the great majority of researchers.
56
57 What Dr. Koop is describing here are some overall studies
58 and has not brought to the readers' attention much of the
59 material that I was describing as being well accepted.
60 For example, the fact, which Dr. Kinlen brought out in his
