Day 031 - 05 Oct 94 - Page 22
1 mutations that eventually ended up as a malignant tumour
2 occurred.
3
4 So I think that is one of the problems about these. It is
5 worse, I think, with cancer. The studies with cancer have
6 been more inconsistent than the studies with coronary
7 heart disease. Part of the problem is that you can
8 measure the blood cholesterol in two people and one will
9 die from a heart attack, the other one will not, and it
10 will be the same blood cholesterol levels. This is due to
11 the fact that we are all genetically different.
12
13 That is the second point why studies on individuals are,
14 to my way of thinking, not necessarily as striking as the
15 studies where you look at very large populations of whole
16 countries and very wide stretches in the diet, because the
17 studies between individuals, the dietary differences are
18 relatively small by comparison with the migration studies
19 or the studies from country to country.
20
21 Q. Has the epidemiological evidence, country to country
22 evidence, been consistent for a number of years?
23 A. Yes, I would say so. I mean, the interesting point
24 about the country to country evidence so far as
25 cardiovascular disease was that Finland was consistently
26 the top of the league in terms of mortality from heart
27 disease. They had one of the highest animal fat intakes
28 in the league table. They then started -- I cannot
29 remember exactly when but it will be late 60s, probably
30 early 70s -- the government started a wide scale
31 intervention programme and it is now Scotland that has the
32 pride of honour of the top place in the league table.
33
34 So, there has been juggling amongst the -- so far as heart
35 disease is concerned, as countries have taken preventative
36 action, but cancer we do not have the same kind of data.
37
38 Q. It has not been going back so far?
39 A. It has not been going long enough.
40
41 MR. JUSTICE BELL: Are the populations of Finland and Scotland
42 about the same?
43 A. I cannot answer that, my Lord. I am not quite sure
44 what you mean. Are the numbers of people about the same?
45
46 Q. It is only if you immediately knew?
47 A. No. My guess is that they are probably similar.
48
49 MS. STEEL: Going on to page 8, line 32, you mention that it
50 is consistently found that the countries with a high
51 incidence of heart disease also have a high death rate
52 from breast and colon cancer and vice versa?
53 A. Yes.
54
55 Q. Could you expand on that a little? Is it the same of kind
56 of distribution?
57 A. Yes. I think I mentioned this earlier, that if one
58 looks at the enclosure 1, Caroll's description of the
59 country to country incidence of colon cancer -- sorry,
60 breast cancer, again you can see that at the top, the pile
