Disease is usually thought to result from a combination of genetic and environmental influ- ences. You are born with a set of genetic materials, received from both of your parents, which predispose you to a pattern of illness. Classic example in T&T would be the disease know as "sinus." "Sinus" runs in families. If your father, or if your mother, had "sinus," then the chances are that you too will have "sinus." But whether you will actually have "sinus" will also depend to some degree on the environment in which you live. If you live in a polluted environment, as we now do in Trinidad (not Tobago, as yet), then the chances that you will develop "sinus" are high. If you move to Grenada or Guyana, then the chances are less that you will have "sinus." So despite being born with the genetic disposition towards "sinus," you may very well not develop it if you live in a clean atmosphere, ie, there seems to be the need for a "trigger" from the environment for the genetic tendency to be expressed as a clinical illness. So it's not always a straight case of "you have the gene, you going to get the disease." It also depends on the environment.
This is especially true for the chronic, degenerative type of diseases like diabetes, high blood pressure, heart attacks, strokes, cancer etc that we are seeing more and more today. Bad genes allied to bad lifestyle (polluted air, water and food; inadequate exercise, and above all stress) equals disease. Recently we have began to change the way we think about the pathogenesis of disease by looking at another environment, the environment of the womb. Pregnancy is no longer considered a nine-month wait for the big event but as a crucial staging period for the development of health or disease in later life. Researchers are beginning to look at adults as "former foetuses, organisms shaped by prenatal experience."Some of the findings of the effects of food, stress, pollutants and emotions on the foetus and on the development of disease in adult life are startling.
One of the first indications that what happens inside the womb affects the development of disease in later life comes from studies of disasters. The Dutch famine of World War II was one of the first examined. From October 1944 to May 1945, the German army enforced a blockade of Holland which resulted in massive famine, killed some 10,000 people and affected 40,000 foetuses in utero. Apart from higher rates of stillbirth, low birth weights and birth defects, people whose mothers were pregnant during the famine were found to have more obesity, diabetes, high blood pressure, poor cholesterol profiles and heart disease than individuals who were gestated under normal conditions. Similar results have been found in China after the failure of Mao Zedong's "Great Leap Forward" and subsequent famine. Individuals born to mothers during fam-ines are also twice as likely to develop schizophrenia. Other alarming results have found lower literacy levels and labour market status for the famine foetuses.
People who were in utero during the 1918 influenza epidemic did worse on just about every socio-economic indicator recorded. Over their lifetimes they were less likely to graduate from high school, more likely to be poor and on welfare and had higher rates of disability and heart disease. Even their height was affected. When they showed up for enlistment in World War II, they were shorter than recruits born the year before or the year after. Studies of Holacaust survivors have found that the offspring of parents with post-traumatic stress disorder (PTSD) during their pregnancies are more likely to develop PTSD themselves than can be accounted for by chance. What's more, the children are more likely to develop PTSD if their mothers and not their fathers had PTSD. The effects of pollutants on the developing foetus are too well known to repeat. Some of the greatest offenders are thalidomide, DES or diethylstilbestrol; alcohol and smoking, both now known to be worse for the foetus than crack cocaine, the endocrine disruptors, BPA or biphenyl A (a synthetic chemical found in many plastic products, including baby bottles and which, since it mimics the effects of female hormone, caused male scientists working with it to grow breasts), and phthalates, found in hairspray, which can cause "incomplete masculinisation of the penis."
Then there is the problem of air pollutants. Babies of women living in areas of Los Angles with severe air pollution have three times the incidence of heart malformations and are 25 per cent likelier to be born preterm than those who live in neighbourhoods with cleaner air. Even a woman's emotional state is now thought to be able to influence a foetus's developing brain and nervous system. Newborns of depressed mothers are more irritable and hard to soothe, have more problems sleeping, have higher levels of the stress hormone cortisol in their blood and later on in their lives have higher rates of emotional and behavioral problems. There's little doubt that the intrauterine environment is a third pathway by which adult illness is passed down in families.
