Day 022 - 12 Sep 94 - Page 43


     
     1        predisposition ---
     2        A.  It is probably true because again with
     3        cardiovascular  -----
     4
     5   Q.   -- which may be sufficient in itself or may have been
     6        played on by some other factor resulting in the
     7        degenerative disease; is that right?
     8        A.  Yes, because if you look at cardiovascular disease,
     9        again the family history is terribly important, you know,
    10        what your parents died of, for example, and the age at
    11        which they died.
    12
    13   Q.   You do not smoke, you can take regular exercise, you can
    14        have a marvellously healthy diet, have a job which does
    15        not involve too much stress and still suffer
    16        cardiovascular disease?
    17        A.  Yes, I am afraid so.
    18
    19   Q.   Because you have inherited it?
    20        A.  That is right.  This is the sad fact that we cannot
    21        choose the genes that we inherit.
    22
    23   Q.   But you cannot get degenerative disease without the
    24        genetic defect; it is a question of whether something else
    25        has to play on it?
    26        A.  Yes.
    27
    28   Q.   And what that may be?
    29        A.  Indeed, yes.  Undoubtedly, you do not necessarily have
    30        to have a family history because genetic abnormalities
    31        occur in all of us in our lives.  There may be some other
    32        stimulus which stimulates by mutation that genetic
    33        abnormality so you do get random cases.
    34
    35   Q.   You could be a member of a Japanese family which moves to
    36        the west coast of America and then be the first person
    37        known in your family to have got breast cancer or
    38        cardiovascular disease or whatever?
    39        A.  Yes.
    40
    41   MR. MORRIS:  When we talk about a jigsaw, it is really an
    42        interplay with lots of different factors?
    43        A.  Yes, indeed.
    44
    45   Q.   In some ways, all equally important?
    46        A.  I do not know that we can say they are all equally
    47        important; some may be more important than others.  The
    48        size of a jigsaw piece may be smaller for some and the
    49        contribution to the overall picture may be greater from
    50        some factors than others, which is often the dilemma of 
    51        knowing what the exact contribution of an individual 
    52        factor is to the development of that disease. 
    53
    54   Q.   The converse of the underlying genetic involvement, almost
    55        by definition, in a degenerative disease is there has to
    56        be, apart from in very exceptional cases where you could
    57        say this was caused by this gene, as you said in the rare
    58        examples, there has to be other factors; if we are going
    59        to prevent diseases we have to look at those other factors
    60        and make recommendations about the other factors?

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