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?
