The day began with Ms Steel requesting further preparation time for the next two sections of the closing speeches (Advertising and Employment) as the defendants were not ready. Surprisingly the judge ruled that the court would not sit the following day but would resume on Wednesday morning. Following his ruling last week on the remaining schedule of the trial, it may be that the judge was somewhat surprised by the plaintiff's admission that they were not yet fully ready to present their own summations - giving some idea of the enormity of the task of summing up, since they are represented by a team of fully experienced lawyers.
Returning to the closing speach on nutrition, Ms Steel then said she wished to remind the court of some of the evidence given by Professor Crawford when he gave evidence for the second time in the trial after McDonald's had changed their Statement of Claim. She said
"it was his view that since submitting his first contribution [in
1994], the evidence relating diet heart disease and cancer had hardened and
that as far as he was aware the World Health Organisation and the Food and
Agriculture Organisation have maintained the same position with regard to
the need to reduce total fat and in particular, saturated fat in diet to
prevent heart disease, it was also believed that would have a common effect
on the common cancers, especially cancer of the colon."
[N.B. This was in response to McDonald's claim that the evidence had got
weaker on diet and disease since 1994]
He had related that in 1990 there were 169,514 deaths from heart disease in the UK (source British Heart Foundation) and that death from heart disease is more than twice as likely amongst those from lower socio economic groups than in the higher economic group (this was also true of cancer figures).
Ms Steel, drawing further from Professor Crawford's evidence, said:
" ... he said that if we were saying that McDonald's food is unhealthy because it is high in fat and low in fibre that there were two points ... he basically said that he agreed that was true, and he agreed that diets that are high in fat and low in fibre are the diets that contribute a real risk to heart disease and he specifically referred to cancer of the colon."
Moving on, Ms Steel drew on the evidence of Professor Colin Campbell, Project Director of the China Oxford Cornell Diet and Health Project:
He had given evidence that
" the findings from the investigation of diet and disease relationships in rural China strongly supported the proposition that a high fat low fibre diet is causal in the development of a wide range of cancers and cardiovascular disease."
The defendants had asked Prof Campbell: "assuming that we establish that typical McDonald's meals are high in fat, sugar and animal products, salt (sodium), low in vitamins and minerals, would a diet of such nature lead to a very real risk that you will suffer cancer of the breast or bowel or heart disease as a result?" He said, yes.
He agreed with the executive summary of the World Health Organisation report 'Diet, Nutrition & the Prevention of Chronic Diseases' which stated that 'The report is explicit in its insistence on the need for a population-wide, as opposed to individualized, approach to the prevention of diet related chronic diseases, arguing that the entire population of most affluent countries shows a high risk profile'.
Further, Prof Campbell had said that the China study revealed that dietary patterns in China were strikingly different from western countries, the major difference being between the consumption of foods of animal origin, he said that animal protein intake for example is 10 fold greater on average in the USA than in China. He went on to state that breast cancer rates, although low in China, were nevertheless greater with the consumption of the typical western diet, high in animal based foods and fat, low in plant based foods.
Summarising Prof Campbell's evidence Ms Steel said that Professor Campbell clearly stated, that there was a direct causal relationship between fat and breast cancer and between fat and colon cancer, and that that was especially true for animal products.
Mr Morris continued after a short adjournment, with some points concerning the evidence of Mr Wheelock (McDonald's witness). Mr Morris said that Mr Wheelock must have been unaware (despite being McDonald's nutrition consultant) that 2-4% of UK McDonald's customers are eating at McDonald's several times a week, which is something like half to a million people.
Moving on, Mr Morris re-iterated the point that the term McDonald's food was generally taken to mean 'hamburgers, chips, milkshakes and colas, in the eyes of the public. The leaflet had clearly stated 'burgers, chips and milkshakes', so all the other products which McDonald's had tried to bring into the equation, [such as salads, pizzas] were irrelevant in terms of the meaning of the leaflet. From Justice Bell's ruling on 'meaning', Mr Morris claimed that the defence only had to show that some people consume such a substantial amount of McDonald's food [3 - 4 times a week] that it may make their diet high in fat, sugar and salt and low in fibre. Mr Morris claimed that the defence have done a great deal more than they had to.
Ms Steel said that when weighing up the evidence of Professor Wheelock (which she said, in actual fact ended up being mostly in the Defendants favour) consideration should be given to the fact that he seemed to have changed his mind since he had become a consultant for McDonald's about whether or not it was a good idea for people to eat high fat snacks. Before he was a consultant for McDonald's, he had published a paper saying it was not a good idea but in the witness box he had expressed the view that it was OK. He had also previously advocated that nutritional information (fat content etc) about products being sold should be printed on the packaging, but he seemed to have tried to water down his views since he had become a consultant for McDonald's.
Ms Steel then said there were a few extra bits of Professor Crawford's evidence which she wanted to refer to:
"I [Prof Crawford] concur with the statement in the disputed leaflet that, 'a diet high in fat, sugar, animal products and salt (sodium) and low in fibre' is considered to be linked to cancers of the breast, bowel and heart disease, on the assumption that the phrase 'animal products' is taken to mean products from conventional farm mammals. A McDonald's meal is likely to fit the above description."
The other point which was particularly relevant in his statement, according to Ms Steel, was that he referred to the NATO workshop on dietary fats and disease, which made the recommendation that food and agricultural practices associated with the high mortality from heart disease, breast and colon cancer of the Western Countries, should not be exported to developing countries where these diseases at that time were not a problem. Ms Steel said that he went on to say that the high profile advertising, exuberant marketing and invasion of Urban Centres by Western foods and fast food outlets such as McDonald's, is seen as playing a significant part in the introduction of these diseases which are new to these parts of the world. So his view, according to Ms Steel, was that McDonald's particularly bore responsibility in introducing dietary changes into the countries which would then have an undesirable effect on people's health.
>From John Hawkes testimony (McDonald's Chief Marketing Officer; UK), Ms Steel revealed that the heaviest users of McDonald's (in the U.K.) were 16 - 24 year olds who also eat a lot of other fast food. Further, drawing from the evidence of David Green (Vice-President of Marketing; USA), Ms Steel said that half of those who eat out (in the USA) chose fast food stores. A third of this figure represented burger joints and 40% of this figure ate at McDonald's.
Amazingly from Mr Green's evidence, 85 - 95% of ALL Americans eat at McDonald's during the year, although a quarter of their customers ('heavy users') made 75% of all visits Ms Steel reported. He said that 11% of visits were from super heavy users who ate there four or more times a week and that it was part of McDonald's marketing strategy to target heavy users to increase their frequency of visits.
Ms Steel then added Mr Green's now infamous claims concerning the nutritional value of a McDonald's diet, claiming that McDonald's food was nutritious since it contained nutrients and can be a part of a balanced diet, and also that coca-cola was equally part of a balanced diet since it provided water.
Mr Green had later actually admitted that McDonald's did not propose that people could sensibly eat McDonald's food as part of a diet largely composed of that kind of food, which according to Ms Steel is exactly what is actually happening in reality.
Mr Fairgrieve's had related that it was virtually impossible to find people who ate at McDonald's but did not use Burger King also. Obviously, Ms Steel added, the reality of the situation is that people generally do not eat a McDonald's meal and then eat healthily for the rest of the week, or even the rest of the day for that matter.
Ms Steel then referred to a Brand Audit Research report produced for the company in 1992, and reminded the court of the following extracts.
People being surveyed described McDonald's as impersonal and rushed.
Heavy users of McDonald's were more likely to be C 1 or C 2 males, under 25 and without children.
McDonald's was more likely to be chosen than competitors in response to kids pestering.
That heavy users were more likely to choose McDonald's on occasions when they were especially hungry. Ms Steel added that the relevance of this was that the Plaintiffs had suggested 'how do we know that these heavy users are not all just going in every day for a cup of coffee'. Clearly, she said, if they are going in because they are especially hungry, they are going to be eating lots of burgers and fries and get a substantial fat and saturated fat load.
People thought that McDonald's food was high in calories and that it was not rated well as being healthy or made with natural ingredients. Only 7% rated the food as healthy and only 8% rated it as being made with natural ingredients. 13% rated it as being greasy and 39% rated it as being high in calories.
The survey related also that "Looking at the McDonald's personality there were some differences between those people who were emotionally close and those who were emotionally distant consumers of McDonald's, the latter described the brands' personality, i.e., McDonald's, as arrogant, impersonal, insincere and brash and that they find this personality less entertaining, willing to listen, thoughtful or kind hearted".
The survey was repeated in 1994, with fairly similar results, 31 percent of the respondents, who were people who ate at McDonald's, indicated that the food was something that they had a craving for, and this was listed by McDonald's as a positive attribute.
>From this same survey the following figures were presented by Ms Steel:
McDonald's food is ...
|... made from natural ingredients||8%||8%|
|... high in calories||39%||37%|
Ms Steel said that it was apparent that from this evidence that despite McDonald's trying to promote their food as nutritous most people, even their own customers recognise it is in fact unhealthy.
Ms Steel went on to refer to calculations made by Mr Fairgrieve of the frequency of visits to McDonald's, based on two other surveys produced for McDonald's (Taylor-Nelson Survey and Fast-Track Survey). His figures showed that up to 0.18% of McDonald's customers (in the UK) ate there 'nearly every day' (which, said Mr Fairgrieve represents some 40,000 people), 1.77-4% ate there several times a week, 8.76-11% once a week. Ms Steel concluded:
"The point being that even on Mr. Fairgrieve's own calculations there are substantial numbers of people who are eating at McDonald's on frequent basis and even if you want to ignore the people that are eating there once a week, there are still somewhere between ... around half a million people and a million people who are eating there several times a week or more often."
Ms Steel said the point to bear in mind were that these were minimum figures for the numbers of people who are eating at McDonald's several times a week. The surveys had been carried out over the telephone, with the preferred interviewee being the head of the household. Thus Ms Steel said the heaviest users, young people, were likely to be excluded from the survey, and also people who did not have telephones, for example, those living in bedsits or in bed and breakfast accomadation, who because of their circumstances were quite likely to be eating at places like McDonald's on a regular basis.
Mr Morris added to the figures of heavy users, stating that some 67% of McDonald's workers eat at McDonald's four or more times a week.
Mr Morris then referred to the evidence of Professor Keen (witness for McDonald's), saying that he had revealed that some 5% of the western population was affected by diabetes and that obesity was clearly shown to be linked with an increased risk of diabetes. Additionally he had accepted the World Health Organisation view that dietary factors are now known to be associated with the development of a wide range of chronic diseases including heart disease, hypertension, diabetes and cancer. Professor Keen had recognised that the WHO report represented state of the art on the state of scientific opinion and that they were regarded with considerable respect.
Ms Steel concluded the nutritional section by referring to the evidence of Ms Brophy (witness for the defence) who was employed by the NHS as a Health Promotion Advisor. She had said that the average McDonald's meal was high in fat, (particularly saturated fat found mainly in animal products), sugar, sodium (or salt) and was low in fibre and some vitamins.
Ms Brophy had given examples of the high fat and sodium content of meals at McDonald's, from meal combinations suggested in the company publication 'Good Food, Nutrition and McDonald's, these were as follows:
Meal combination 1 of: "Big Mac, large French fries and apple pie and
Meal combination 2: "Hamburger, regular French fries and milk".
(To obtain the amount of kcals from grammes of fat - multiply grammes times 9 as one gramme of fat equals 9 kcalories.)"
She said that the UK Govt recommends a maximum of 35% of energy (kcalories) as fat, which is much lower than a typical McDonald's meal of 45% fat. She went on to say that the UK Govt fat recommendations are moderate compared to other international reports, such as the WHO which recommmends a maximum of 15-30% of energy as fat. The UK Govt target of 35% was an arbitrary figure picked out because the Government decided they might be able to achieve that. The actual target that would benefit peoples' health would be nearer the 15-30% as recommended by WHO. Ms Brophy's view was that we should go towards the lower limit of 15% to prevent people dying from preventable diseases, including heart disease/stroke, and some types of cancer (inc bowel, breast and others).
Ms Brophy had gone on to say that the sodium content of a typical McDonald's meal combination (1,488 milligrams) is close to the maximum recommended by the Government of 1,600 milligrams and is above that recommended for a ten year old child of 1,200 milligrams per day. Consumption of a cheese sandwich in addition to a McDonald's meal would easily push the sodium content above the adult daily recommended amount.
She added that similar calculations could be made which showed that a typical McDonald's meal is also lacking in fibre, fresh fruit and vegetables and certain vitamins.
Her experience as a dietitian suggested that people might consume a hamburger, French fries and milk and then, for an afternoon snack, they might have a Mars Bar which is also high in fat. Mr Rampton had agreed with this. Ms Brophy went on to say it may theoretically be possible to do what McDonald's suggest [eat a McDonald's meal and then balance the rest of the diet], but in practice nobody would actually do that, it would be almost unheard of. People would not eat a McDonald's meal and then go away and eat healthy low fat meals the rest of the time, she said 'it is not the way people eat'.
Ms Steel then made reference to the NACNE report produced in 1983, which set out how the term balanced diet came about, and recommended a new approach avoiding use of the term "balanced diet". It suggested the term "a healthy, varied diet" as a better phrase. Ms Steel then told the court of Ms Brophy's view that people need to be given guidelines in terms of what foods they should be eating more of and what foods they should be eating less of. A 'balanced diet' can mean almost anything to anyone and can be interpreted in whatever way people choose.
Moving on specifically to the evidence on the risks of an unhealthy diet, Ms Brophy stated that a poor diet that is low in fibre, fresh fruit and vegetables and high in fat and animal products has been scientifically linked with some cancers, particularly bowel cancer and heart disease, and that it has been estimated that 30-70 per cent of all cancers are linked to diet and certain cancers, such as bowel, breast and prostate are clearly diet related by cancer expert Professor Doll (1990 Symposium on Diet and Cancer). The concensus by the Health Education Authority is that around 35% of cancers are diet related.
Ms Steel finished by quoting from the WHO Report:
" Evidence indicates that a diet which is low in total saturated fat, high in plant foods, especially green and yellow vegetables and citrus fruits and low in alcohol, salt, pickled, smoked and salt preserved foods is consistent with a low risk of many of the current major cancers, including cancer of the colon, prostate, breast, stomach, lung and oesophagus."
The court then adjourned until 10:30 AM Wednesday 13th when Ms Steel will begin Advertising.