Day 297 - 08 Nov 96 - Page 14


     
     1        eat, hence no doubt the story we all read about people who
     2        smoke 40 a day dying when they are a hundred, and it may
     3        very well be that if you have particular genetic mutations
     4        there is a very high risk indeed that you will develop
     5        cancer.
     6
     7        Hence, looking at the family background, quite regardless
     8        of any argument along the lines of, Oh, well, mother and
     9        daughter probably have the same kind of way of life,
    10        including much the same kind of diet, but that does not
    11        brush aside the question of how great the risk is.  It
    12        still brings in, allows arguments, that if you follow a
    13        certain kind of diet the risk is greater because a certain
    14        proportion of the population have the necessary gene
    15        mutation, and then in assessing whether there is next to no
    16        risk, middle risk or high risk you may be entitled to look
    17        at the diet, or kind of amount of exercise they have taken,
    18        and all these other environmental factors.
    19
    20        So at the moment I don't see that saying that it all goes
    21        back to your genes decides the matter against you at all.
    22        But I merely say that out aloud unless I have...  You can
    23        argue on the base of it for the Plaintiffs and against you,
    24        or for you and against the Plaintiffs.  It may be a factor
    25        without which there could never be cancer of a particular
    26        kind and in a particular person.  But if you assume that a
    27        certain proportion of the population have the gene
    28        mutation, or no one in the population would ever get that
    29        kind of cancer, then you have still got to look at what the
    30        other factors are which increase the risk of them actually
    31        developing it, and that brings me back to my point about, I
    32        see no difference between promotion and it is all part of
    33        the end result, which is-----
    34
    35   MS. STEEL:   I am working on that definition of cause now, that
    36        it includes promotion.
    37
    38   MR. JUSTICE BELL:   Anyway, I have spoken, thought aloud as it
    39        were, so that anyone can pick me up on that if they think I
    40        have been going down the wrong route.
    41
    42   MS. STEEL:   Well, I mean, I agree, because I think obviously
    43        there is a risk, there are people who are genetically
    44        predisposed.  The point is that nobody knows whether or not
    45        they are in that category until it is too late, really.  So
    46        everybody has to act as if they have got a risk, because
    47        they are just not going to know whether or not they have
    48        some kind of genetic protection, whatever.
    49
    50   MR. MORRIS:   I mean, the point is that the World Health
    51        Organisation and the witnesses agreed that the whole
    52        population of western countries are a high risk profile
    53        situation, and the point is that some people in those
    54        countries are additionally at risk on top of that because
    55        of the genetic propensity or vulnerability in other ways or
    56        because they already have the disease and do not know it,
    57        or whatever.
    58
    59   MR. JUSTICE BELL:   I am not sure that is right.  I do not think
    60        they are additionally at risk because of their genetic

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