date signed:
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September 27th 1994
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My special knowledge is of diet, nutrition and health, including diet, nutrition
and cancer. I do not wish to make any statement on other aspects of the
case. I am:
- Author of `Food and Health: The Experts Agree' published by Consumers'
Association in 1992. This records the scientific consensus on diet and disease.
- Chairman of the National Food Alliance and as such a member of HMG's
Nutrition Task Force, charged to make government-approved nutrition targets
work.
- A member of HMG's official delegation to the FAO/WHO International Conference
on Nutrition held in Rome in 1992.
- Director of Science for the World Cancer Research Fund (WCRF) whose
remit is to reduce cancer risk by diet. Hence this letterhead.
Relevant documents under these headings are:
- Copies of `Food and Health: the Experts Agree' (1992) with relevant
pages on diet and cancer and also diet and chronic diseases identified.
- Copies of the National Academy of Sciences report `Diet, Nutrition and
Cancer' (1982) with recommendations identified.
- A copy of the World Health Organisation (WHO) report `Diet, Nutrition
and the Prevention of Chronic Diseases (1990) with relevant pages identified.
- Copies of `Eat Well...Live Well' produced with support from the Health
Education Authority, to accompany the 1990 WHO report above.
- A copy of the final report of the ICN endorsed by all nations of the
UN present in December 1992, with the relevant passage identified.
- The current annual report of WCRF; its current scientific research grant
announcement; and a WCRF quarterly, `science News'.
- The US government position on diet and cancer as summarised in the DHHS
report Nutrition and Health in 1988. Relevant tables also shown.
- The European Code Against Cancer as promulgated throughout the EU. October
10th -16th this year is Europe Against Cancer week, its theme diet and cancer.
Some comments, based on these qualifications and documents:
Current State of knowledge on diet and chronic diseases
What follows is a summary of what is now accepted by authoritative scientific
bodies, international organisations like WHO, and by governments. It is
not a personal opinion. It is generally accepted by authoritative scientific
bodies that a diet high in fatty meat, dairy products, fat, saturated fat,
sugar and/or salt, and correspondingly low in vegetables, fruit, starchy
foods, and fibre, such as that typically eaten in the UK, is an important
cause of disorders and diseases that are disagreeable (eg tooth decay, constipation),
debilitating (obesity, diseases of the bones and gut), and also deadlv (stroke,
heart attacks, and various cancers induding - those of the breast and colon).
This judgement is based on strong scientific evidence of all types (epidemiological,
experimental, biological). Some individual scientists have doubts or disagree.
Current state of knowledge on diet and cancer The evidence on diet and cancer
specifically is also voluminous, and has been judged as a sufficiently reliable
basis for recommendations addressed both to health professionals and the
general public by the
- US National Academy of Sciences (1982)
- the American Institute for Cancer Research (1982)
- the American Cancer Society and the National Cancer Institute (since
the mid 1980s)
- the EU- backed Europe Against Cancer initiative (in the 1990s)
This evidence is also incorporated in broader statements made by the US
government (since 1988) and WHO (Diet, Nutrition and the Prevention of Chronic
Diseases (1990).
Recommendations made by all these bodies are harmonious and consistent with
those on heart disease and other diseases. There are differences in emphasis.
and it is also evidently true that different cancers have somewhat different
dietarv causes. For example, the evidence that a diet high in meat as
typically eaten in the UK is an important cause of colon cancer, is agreed
to be very strong, and with cancer a diet high in fat generally, not saturated
fat in particular, evidently increases the risk of various cancers.
The scientific consensus on diet and cardiovascular disease was accepted
by government in the UK in 1984. The consensus on diet and cancer was accepted
by government in the US in 1988. In the UK, government has now commissioned
its official advisory COMA committee to review the evidence on diet and
cancer and to make recommendations.
As with cardiovascular diseases, the scientific consensus on diet and cancer
(or rather cancers) is now based on literally thousands of epidemiological
and experimental studies. Some individual scientists have doubts or disagree.
All expert consensus statements issued by authoritive scientific and research
bodies, by governments, and by international bodies in the last twelve years
on diet and cancer, have basically come to the same conclusion, which is
that a diet rich in vegetables, fruit and cereals (preferably wholegrain)
protects against cancers, and that a diet high in meat, fatty foods, fat
and salty fbods, and also alcohol, increases the risk of cancers. All these
aspects of the diet evidently increase the risk of cancer (or some cancers)
independently of each other.
No authoritative statement issued in the last twelve years
on diet and cancer comes to a substantially different conclusion.
Having read transcripts of some of the court proceedings I have some other
comments.
Complexity:
The science of diet and cancer, and of diet and other diseases, is very
complex. However, the state of scientific judgment based on the evidence,
is straighforward, and is summarised above.
Genetics
All diseases have a genetic aspect; what this means, is that we are all
born more or less vulnerable to different diseases. This does not mean that
we are bound to suffer those diseases to which we are born susceptible.
Geographical and historical comparisons show that cancers have a comparatively
small genetic aspect. If you are genetically vulnerable to colon cancer
(say) but eat an appropriate diet (and do other prudent things) you are
almost always unlikely to get the disease.
Diet
With smoking, diet is now generally agreed to be the major factor influencing
risk of most cancers. As stated, the diet generally agreed to protect against
most cancers is plant-based: rich in vegetables, fruit, and cereals (preferably
wholegrain) with foods of animal origin (meat, meat products, milk, dairv
products) enjoyed only occasionaily.
Proof
There is some confusion about what constitutes proof, in the life sciences,
such as nutrition. There is no such thing as absolute, total, final, 100
per cent proof in this field. The best standard of proof is the same as
that accepted in criminal proceedings: proof beyond reasonable doubt. There
is always likely to be some unclear or contradictory evidence. When scientific
bodies and governments issue dietary guidelines designed to reduce the risk
of diseases, what this generally means is that based on the evidence, they
believe the case is proved beyond reasonable doubt. Expert committees set
up by authoritative bodies and by governments thus have a judicial function.
They review the evidence and make a judgement based on this evidence. Thus
in the case of diet and cancer it could be said that every time a diet high
in meat, meat products, fatty food generally, dairy products, and salty
food, such as that typically eaten in the UK, has been brought to trial
in the last dozen years, the verdict has always been Guilty.
Cause
There is also some confusion about what constitutes cause, in the biological
sciences. It is rather misleading to say that fatty meat and meat products
(etc) cause cancer, just as it is misleading to say that smoking causes
cancer. Nobody believes that smoking one cigarette is a death sentence.
It is more accurate to say that regular smoking increases risk of cancer
and that the more you smoke the greater the risk likewise, it is more accurate
to say that a diet high in fat, fatty meat and meat products (etc) increases
the risk of cancer, and the fattier (etc) the diet, the greater the risk.
Nourishing
What `nourishing' means, is nutritious or health-giving, which is to say,
relatively rich in nutrients. Any diet and meal and indeed any food by
definition contains nutrients (if energy is defined as a nutrient). This
does not mean that it is nutritious.
The published statement made by London Greenpeace complained
of by McDonalds is:
A diet high in fat, sugar, animal products and salt (sodium) and low in
fibre - which describes a typical McDonald's meal - is linked with cancers
of the breast and bowel, and heart disease. This is accepted medical fact.
Compare this with the statement issued by the International Conference
on Nutrition in Rome, agreed by all UN member states:
With greater affluence and urbanisatlon, diets tend to become richer
on average in energy and fat, especially saturated fat, have less fibre
and complex carbohydrates with more alcohol, refined carbohydrates and salt.
In urban settings exercise and energy expenditure frequently decrease, while
levels of smoking and stress tend to increase. These and other risk factors,
as well as increased life expectancy, are associated with the increased
prevalence of obesity, hypertension, cardiovascular diseases, diabetes mellitus,
osteoporosis and some cancers with immense social and health care costs.
The UN-approved statement does not mention McDonalds, includes reference
to some non-dietary risk factors, and is rather more comprehensive, referring
to obesity, high blood pressure, diabetes and osteoporosis as well as cardiovascular
disease and cancers.
Otherwise these two statements seem to me and may seem to
the Court to be similar.
references: Not applicable/
available
exhibits: Not applicable/
available
date signed:
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July 21 1993
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status:
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Appeared in court
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transcripts of court appearances:
related links: