Day 022 - 12 Sep 94 - Page 39


     
     1
     2   Q.   But you feel that you could put your hand on your heart
     3        and say:  "This is causing that"?
     4        A.  No, all I can say -----
     5
     6   Q.   Genetically?
     7        A.  All I can say is that it is very likely that there is
     8        a genetic relationship ---
     9
    10   Q.   Right.
    11        A.  -- a genetic factor in the causation of bowel cancer.
    12        I mean, ultimately, cancer, in fact, is a disease where
    13        you have genetic abnormalities, otherwise the cell would
    14        just carry on in a normal fashion.  But something changes
    15        in the essential makeup of the cell for it then to go on
    16        and become a malignant cell which is beyond the control of
    17        the normal control mechanisms of the body.
    18
    19   Q.   Something that strikes me as you were talking is -- it is
    20        a  question I wanted to ask all along -- presumably, there
    21        may be a compounding of three or four different factors
    22        that have to come together to make a particular cancer.
    23        So, for example, although you could say the genetic path
    24        is the main one, that would not be possible without, for
    25        example, the dietary component, the high fat in the diet
    26        or something?
    27        A.  It is possible.
    28
    29   Q.   Although it may not be the cause?
    30        A.  No.  I mean, we talked about this when I gave evidence
    31        before.  There is the process of initiation which is,
    32        presumably, the formation of the genetic abnormality which
    33        one often cannot detect in the cell.  It is not detected.
    34        Then one has to have promotional of that.  Then there is
    35        the progression subsequently.  Now, it may well be that
    36        the factors which are involved in the promotion of this
    37        abnormality are different from the factors which act when
    38        you are getting progression of the cancer.
    39
    40        This is why it is so difficult in this question of diet
    41        identifying, you know, what aspects of diet are important,
    42        at what stage do they act in this process of initiation to
    43        cancer progression.
    44
    45   Q.   If there are two populations with very strongly different
    46        cancer rates and strongly different dietary habits --
    47        forget the dietary habits, strongly different cancer rates
    48         -- but no obvious genetic link which could be backed up
    49        by migration studies, presumably, that carry the genetic
    50        genes with them but they change their cultural situation 
    51        or whatever, then the genetic -- you could not put your 
    52        hand on your heart and say ----- 
    53
    54   MR. JUSTICE BELL:  Pause a moment.  Start the question again
    55        because long questions can not only leave the person who
    56        is asking it (but more important the person listening to
    57        them) confused, so collect your thoughts and then put the
    58        question.
    59
    60   MR. MORRIS:  It is not a trick question.

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