Day 252 - 20 May 96 - Page 25


     
     1        So, ideally, if you have two treatments it is a good idea
     2        to have them simultaneously and then have a crossover and
     3        repeat it again.  So that this takes account of secular
     4        changes.  And this was done in neither of these studies.
     5
     6   Q.   The comments you made about vascular activity, you said
     7        that you had no expertise in that area.  So what you said
     8        was all based on what you had been told?
     9        A.   No, I could understand exactly what had been done here
    10        but I sought advice on what significance it had.  To me it
    11        seemed a very unphysiological thing to completely cut off
    12        the blood flow in a blood vessel for 5 minutes and allow
    13        the blood vessel to expand to its maximum extent, because
    14        that sort of thing simply does not happen to a blood vessel
    15        in everyday life.  So I questioned the relevance of that to
    16        making comments about diet in relation to everyday life,
    17        and the advice I got was that, well, I will not tell you
    18        exactly what was said, but it was thought that this work
    19        was of no great significance at all and certainly would
    20        have to be repeated.
    21
    22   Q.   That is what somebody else said to you?
    23        A.   Well, I come to much the same conclusion myself
    24        because of the unphysiological nature of this test.  It is
    25        surprising how many physiological tests are
    26        unphysiological.  I mean, the standard glucose tolerance
    27        test for measuring or assessing whether one has or has not
    28        diabetes is a terribly unphysiological thing to do but it
    29        has been done for 50 years or more.
    30
    31   Q.   In the second study you said that there was not a very
    32        -- that the range of fat intake was not very great.  There
    33        was 40 and 30 percent, so you feel that a wider range would
    34        have been more useful for determining any effects?
    35        A.   Yes.  If this was a paper that was actually read at a
    36        scientific meeting I would have asked the people who did
    37        it, 'How did you monitor for consumption of these two
    38        diets, how did you check on whether people were actually
    39        doing what they had been told to do'.
    40
    41   Q.   That was not quite what I asked.  What I am asking about is
    42        in terms of the percentage of--
    43        A.   Yes, I would agree the contrast was not very great.
    44
    45   Q.   Right?
    46        A.   If they really did consume 40 percent and 30 percent
    47        it is not a very great contrast.
    48
    49   MR. JUSTICE BELL:   But is that, for instance, because the
    50        difference between 155 and 162 is not very great, you say, 
    51        and between 94 and 108, for instance, or it is because if 
    52        you take 155 plus ten, one at least of the NCEP2 group is 
    53        more than 162, and if you take 162 less 21, one at least of
    54        the high fat group is less than 155.  Or is it a
    55        combination of both those approaches?
    56        A.   Well, where you see a figure like 155 plus or minus
    57        sixteen.
    58
    59   Q.   It is sixteen is it?
    60        A.   Is it sixteen?  It is very difficult to read this.

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