Day 034 - 11 Oct 94 - Page 05

     
     1        limited) dimensions of the human epidemiologic studies of
     2        diet and breast cancer".  Again, the Surgeon General is
     3        concluding, back in 1988, that there is strong evidence
     4        that not only is fat related to cancer but that that
     5        relationship is, indeed, causal.
     6
     7   MR. JUSTICE BELL:  Where do you get that from?  Where do you
     8        get "is causal"?
     9        A.  What I am suggesting, or what I hope to say, is that
    10        the Surgeon General is saying that the evidence does
    11        strongly suggest that the evidence is causal, not that the
    12        evidence is conclusive, that the relationship is causal.
    13
    14   Q.   He uses the word "may", which is why I ask why you say
    15        "is".  Are you looking at something else?
    16        A.  No, no; simply that if the data suggests that the
    17        relationship is causal, suggestive rather than definitive,
    18        but you are right -- his words were "may be causal".
    19
    20   MR. MORRIS:  So, Dr. Barnard, are you saying that the
         association is established?
    22        A.  The association ----
    23
    24   Q.  - and that what the Surgeon General is saying that there is
    25        an association which is strongly suggestive it may be
    26        causal?
    27        A.  That is correct.
    28
    29   Q.   That is backed up by the first paragraph?
    30        A.  That is correct.  I am not intending to say that the
    31        Surgeon General felt that the association clearly was
    32        causal or is causal; simply that the evidence for such a
    33        relationship is strong, for a causal relationship is
    34        strong.
    35
    36        Turning to table 4-7 on pages 196 and 197, the Surgeon
    37        General took note of four different types of studies,
    38        international correlations, within country correlations,
    39        case-control studies and -----
    40
    MR. JUSTICE BELL:  Just let me read the rest of that paragraph,
    42        Dr. Barnard, to the top of page 195.  Do you have any
    43        comment on the rest of that paragraph?
    44        A.  No, my Lord, other than to say that one would
    45        certainly agree with the Surgeon General's interpretation.
    46
    47   Q.   Thank you.  Then you went to page?
    48        A.  Pages 196 and 197 in which the Surgeon General has
    49        briefly reviewed evidence and, rather than go into what
    50        looks to be perhaps 30 studies, I might just briefly 
    51        describe the studies overall. 
    52 
    53   MR. MORRIS:  Can I ask you a question:  Why has he chosen these
    54        particular studies?
    55        A.  Presumably, because they were well designed and well
    56        conducted studies.
    57
    58   Q.   So they are not an arbitrary selection?
    59        A.  No, not arbitrary, nor would there be any evidence of
    60        bias in selection.  In making 32 references on these two