Genetics determine our fate at the moment of conception, when a particular sperm cell fertilizes a particular egg cell. If the process results in some faulty genes, then that’s how it’s going to be.
That said, genetics isn’t always a sentence. More often than not genetics simply means that the person with these genes is more likely to get some particular condition than the average person. Like, say, on average 5% of people get diabetes at some point in their lives, but the genetics of this particular person make the probability of getting diabetes 20% for them specifically (I’m making numbers up here).
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