Day 031 - 05 Oct 94 - Page 21
1 A. Well, if, for example, there was a report from India
2 of a high incidence of heart disease, particularly
3 southern India, a local person might ask "What sort of
4 heart disease are you talking about"? Because it might
5 not be the same kind of heart disease that we would have
6 in Europe. In particular, in Uganda (which I have first
7 hand knowledge of) I can give that example because they
8 have several forms of heart disease, but they were not the
9 same types of heart disease. They were types of heart
10 disease that affected the muscle and the lining of the
11 heart, not the arteries of the heart.
12
13 So, a person who knew about this would immediately say:
14 "Wait a minute, we cannot put those statistics into the
15 same bag as we put mortality from cardiovascular disease.
16 We have to put it in a different bag because it is a
17 different type of heart disease". That is, I think, where
18 local knowledge would flag discrepancies.
19
20 MS. STEEL: Presumably, if statistics only recorded a tiny
21 number of people who were suffering from breast cancer,
22 but people in the field were aware of lots of cases, then
23 that would be a discrepancy that would be flagged up?
24 A. It would be, yes.
25
26 Q. Is it usually the case that there are responsible medical
27 people in these areas who would be aware if, I do not
28 know, the mortality rates or disease rates were incorrect
29 from their own knowledge?
30 A. Yes. I mean, I think it is presumptuous to imagine we
31 are the only people in the world that keep reasonable
32 statistics. Many of the developing countries actually
33 have quite good medical research councils, particularly
34 the ones which have a British history attached to them.
35 They have good medical registries at their hospitals. I
36 feel confident that the kind of statistics that we see
37 from country to country that are being reported on are
38 telling a true story. There may be decimal places that
39 are inaccurate, but they are telling a true story.
40
41 Q. The studies on individuals -- this is going on to page 5
42 -- have been criticised on the grounds of inconsistency.
43 Do you think the fact that there is inconsistency means
44 that we can ignore all the other evidence, or do you
45 believe that the evidence in terms of epidemiological and
46 experimental evidence is so strong that -- perhaps it is
47 easier if you explain?
48 A. Yes. There is an inconsistency in the studies on
49 individuals. This was true of the studies, similar
50 studies, which were done much earlier in relation to
51 cardiovascular disease. You do get inconsistencies when
52 you look at people within a population.
53
54 A lot of that inconsistency is due to at least two
55 factors. Firstly, the time at which you do the study is
56 distant from the initiation of the problem. So, if you
57 look at somebody's diet today, this may have little
58 bearing but may accurately reflect (and it is difficult to
59 tell with confidence) the diet at the time that the real
60 seeds of coronary heart disease were being sewn, or the
