Day 036 - 13 Oct 94 - Page 14


     
     1        not be determined in these analyses".
     2
     3        I take it, Dr. Barnard, those are qualifications or
     4        reservations expressed there which can often be made in
     5        relation to prospective studies in homogenous populations?
     6        A.  Yes, particularly if it is short term.
     7
     8   Q.   Yes, particularly if it is short term.  Can one also say
     9        this, do you think?  The larger the cohort that is studied
    10        the less powerful that those qualifications become?
    11        A.  A larger cohort can be helpful.
    12
    13   Q.   Because you are likely to get, though, in one sense, the
    14        population remains homogenous, you are likely to get a
    15        wider range of intakes, are you not?
    16        A.  That would not necessarily follow, no.
    17
    18   Q.   But you stand a better chance of doing so, do you think,
    19        or not?
    20        A.  No, not necessarily.  The range of diet may depend on
    21        things quite apart from the size of the sample one has
    22        recruited.
    23
    24   Q.   I quite well accept that if you survey the members of the
    25        American Meat Association, or something, you might not get
    26        a very wide range.  Now I would like you to turn over,
    27        please, to page -- I have not a number for it, I am afraid
    28         -- it is the next page; I imagine it is 470.  I will just
    29        read the conclusion, which is the last part of this
    30        study.  The last paragraph:  "This study is an important
    31        addition to the examination of diet and breast cancer
    32        because of its prospective nature in which careful dietary
    33        assessment was carried out prior to ascertainment of
    34        breast cancer status.  The NHANES I survey that provided
    35        this cohort sampled from a large cross-section of the US
    36        population, and thus these data do not focus primarily on
    37        the upper-socioeconomic-class women at higher risk of
    38        breast cancer who are usually the focus of breast cancer
    39        studies."
    40
    41        Pause there, please, Dr. Barnard:  Why is it that, at any
    42        rate at this date in 1987, it was the
    43        upper-socioeconomic-class women who in the United States
    44        were at a higher risk of breast cancer, do you think?
    45        A.  They do not say whether that is in the United States
    46        or elsewhere.  This study was in the United States.
    47        I believe the phrase you are referring to does not
    48        particularly specify which population, but what they are
    49        referring to is that the upper, I presume what they are
    50        referring to, is the upper-socioeconomic-classes are well 
    51        known for consuming more animal products, more animal fat 
    52        in general. 
    53
    54   Q.   Would it not also be, Dr. Barnard, that they marry later
    55        and have fewer children?
    56        A.  I could not say that that is the case, and one of the
    57        situations that we have in the United States is that a
    58        high-fat diet, regrettably, is pervasive through virtually
    59        the entire population except those who have taken steps to
    60        limit fat intake.

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