Preemies, Genes, Meritocracy, and the Left

the vagaries of chance are at the heart of all left wing politics

Though I’ve presented at academic conferences and invited talks many times, I’ve only really shared my various thoughts on education at public events a handful of times. Even so, I have enough experience to know that there’s a particular influence on academic performance that people find instinctively touchy: the influence of premature birth and birthweight. In a world in which prospective parents are known to freak out about everything all the time, I find it strange that more people aren’t aware of the consistent research finding that children who are born prematurely, particularly at very low birthweight, on average face serious academic challenges. I stress, these are averages, and plenty of people born prematurely go on to great academic success. But in aggregate the effect is large, persistent, and it scales. In a completely crude way, this seems pretty straightforward: less time in the womb provides less time for fetal brain development, and a majority of neurogenesis occurs in the womb. Though I’m sure the actual neurological processes are very complicated, you can probably safely say that babies just need enough time in the oven for their brains to cook. And it’s not like this evidence is new or this phenomenon undiscussed. A meta-analysis of 14 studies from 2009:

Combined effect sizes show that very preterm and/or VLBW children score 0.60 SD lower on mathematics tests, 0.48 SD on reading tests, and 0.76 SD on spelling tests than term-born peers. […] effect sizes for EF revealed a decrement of 0.57 SD for verbal fluency, 0.36 SD for working memory, and 0.49 SD for cognitive flexibility in comparison to controls. Mean age at assessment was not correlated with the strength of the effect sizes. [That is, the effects are persistent - FdB] Mathematics and reading performance, parent ratings of internalizing [behavioral] problems, teacher ratings of externalizing behavior, and attention problems, showed strong and positive correlations with mean birth weight and mean gestational age.

The earlier a premature baby is born, the lower their birth weight, the more likely they are to suffer from significant cognitive and academic deficits. This meta-analysis was specifically looking at babies born earlier than about 8 months, or very preterm. But note that other studies have found that there are measurable cognitive effects from prematurity without term restrictions. This meta-analysis from 2017 includes data from more than 64,000 children who were born preterm.

Main results

We included 74 studies (64 061 children). Preterm children had lower cognitive scores for FSIQ (SMD: −0.70; 95% CI: −0.73 to −0.66), PIQ (SMD: −0.67; 95% CI: −0.73 to −0.60) and VIQ (SMD: −0.53; 95% CI: −0.60 to −0.47). Lower scores for preterm children in motor skills, behaviour, reading, mathematics and spelling were observed at primary school age, and this persisted to secondary school age, except for mathematics. Gestational age at birth accounted for 38–48% of the observed IQ variance. ADHD was diagnosed twice as often in preterm children (OR: 1.6; 95% CI: 1.3–1.8), with a differential effect observed according to the severity of prematurity (I² = 49.4%, P = 0.03).

Conclusions

Prematurity of any degree affects the cognitive performance of children born preterm. The poor neurodevelopment persists at various ages of follow up.

It’s not hard to understand why this is a particularly sensitive dynamic. While there are certain risk factors associated with preterm births, babies being born prematurely is fundamentally an act of God, not something anyone can prevent. Prematurity, to put it another way, is out of anyone’s control, including the type of people who have come to parenthood with a deep conviction that they can control everything. Parents of all types are of course very protective of their children and want all possible opportunities to be available to them, and academic potential in particular has somehow become even more intensely valued by parents in recent years. The “knowledge economy” has instilled an even deeper sense of panic and desperation over academic performance in parents and students alike, and elite colleges refuse to expand the size of their incoming classes, resulting in a brutal hunger games for our adolescents. In a world where parents will call teachers at home to try and grade grub an A- into an A, the effect sizes listed above are a crisis, an earthquake. This is a recipe for an exquisitely sensitive issue.

This dynamic is so sensitive, in fact, that I’m willing to bet a very large percentage of the people reading this have never heard of it at all.

It’s strange, isn’t it? Parents are inundated with things to worry over when it comes to their children, and even if they weren’t, many modern parents would seek worry out. (Many modern parents think the quality of their parenting varies directly with the amount of their worry.) And so we’re culturally aware of the cognitive influence of lead, of the academic impact of when a child is born and how that influences their schooling cohort, of the (supposed) academic benefits of breastfeeding. Parents fret over potential variables that have dramatically lower risks of reducing academic performance. Yet despite the fact that one in ten children is born preterm, and that decades of research establish that the academic impact of premature birth is larger than most of the influences that parents freak out about, few parents are aware of this consistently-replicated finding. I suspect that this ignorance stems from the pure, unadulterated unfairness of all of this - this reality is so obviously unfair, so deeply emotionally injurious, and plays so directly to the irrational guilt parents feel over their children that nobody feels particularly motivated to talk about it. You can do something about some of the potential bad influences on your kids academic success, though the effects are generally small. If you live in a state without robust lead testing requirements in the home buying process and your house wasn’t new construction when you bought it, you can and should pay the ~$500 to get your home tested for lead. But what do you do with something that you can’t control, that depends on the one-time-only event of birth, and which has persistent negative influence deep into their adolescence?

Well, you can’t do a lot beyond loving your kid regardless of their academic performance. (Spoiler alert: in the end, all you as a parent control is loving your kid.) But we can build the kind of world where they don’t have to suffer because of the vagaries of fate, where we decide as a society that people shouldn’t be defined by those things that the individual can’t control, that their parents can’t control, that nobody can control. And this is the heart of all left politics, deciding that everyone deserves not only certain rights but certain guarantees regarding the conditions they live under regardless of anything specific to them - guarantees of food, clothing, shelter, healthcare, education. While many people reject both that philosophy and its policy specifics, it’s difficult to imagine many actually-existing human beings who believe that preemies might deserve depravation and suffering because that status may have damaged their ability to thrive in the market economy. Liberals and lefties, at least, can be trusted to demand that those born prematurely not face systematically worse outcomes because of that bad luck.

What I can’t figure out is why that same group of people is so often unwilling to discuss the influence of genes on life outcomes at all.

---

One of the challenges of marketing The Cult of Smart was that I never settled on a good elevator pitch. Still haven’t. When people ask me what it’s about, I have like three different approaches to laying out the various elements of its argument. This is not ideal from a publicity standpoint. Let me try a bulleted list format, the length of which will speak to my inability to summarize this thing.

• Over the course of centuries, the market value of intelligence, education, and general cognitive ability has grown; we now live in a “knowledge economy”

• These skills and abilities have naturally become deeply intertwined with the justification for modern meritocracy, which is to say, the notion that our system rewards or should reward the ability of the individual, their capacity for performing valuable tasks, rather than (for example) their station within a system of hereditary nobility

• In the lived, casual moral philosophy that most Americans operate under, this system of meritocracy and the outsized rewards that come with cognitive/educated/skilled labor is justified because the individual can determine their outcomes within the system; if you’re smart and hardworking, you control your own destiny and can achieve the kind of lifestyle you want

• If the individual doesn’t control their own destiny, if chance plays an outsized role in determining life outcomes, then there’s little reason for the average person to play ball within the system - why put your head down and be a good little worker bee if there’s no consistent relationship between your willingness to do so and the rewards you reap?

• This whole edifice of modern post-nobility society, therefore, rests on a foundation of the belief that we all have equal opportunity to excel; not coincidentally, at precisely the period when dynastic systems of nobility began to crumble, Western philosophers began to stress a philosophy of equal rights in a society governed by principles of personal liberty and market economics (that is to say, liberalism)

• But while we are all equal in rights, in value, and in human dignity, we are very much not equal in ability, which is a reality we are perfectly willing to countenance in certain fields (athletics, music, physical beauty) but not when it comes to academics

• Unfortunately, we know that not all people are in fact equal in academic or intellectual potential, even if we deny any particular genetic influence on intelligence at all - see, for example, the consequences of prematurity

• Once we acknowledge that not everyone has equal potential in every academic skill, the basic justification mechanism of modern capitalist society begins to break down, and perhaps we can critically examine the assumptions that underpin it

• If we are not all made equal in our abilities, particularly in the classroom, the current American fixation on creating opportunity through turning every student into a budding Google software engineer becomes particularly perverse, destined to leave many behind who are additionally blamed for their own failure

• Decades of education research demonstrates that early-life academic performance is remarkably stable throughout schooling, even in the face of concerted efforts to change that performance

• Despite endless propaganda, there is no simplistic relationship between the performance of the median student and the economic, diplomatic, military, or cultural strength of a given society, all of which are likely dependent on the abilities of a small percentage of the highest achievers

• Academic skills are only one small slice of the human project, and all people have something of value that they can contribute, only a tiny percentage of which is covered in grades or test scores

• We would do well to further expand our redistributive social safety net (political), reduce artificial standards and open up more paths through K-12 schooling to account for different skills and interests (educational), and cease our obsessive focus on intelligence and academic ability as the central criterion of being a successful human (cultural/social).

Some things that The Cult of Smart is not include

• An argument for pseudoscientific racism, AKA “race science”; the genetic influence I’m interested in here is individual, not racial, and I explain the distinction and my reasons at length here

• A justification for Marxism; though I am a Marxist, and the book concerns our fundamental system of achievement and reward, I wasn’t interested in writing about Marxist economics or politics in this book out of a desire to expand its audience, which is (in a strange way) rather reformist in its orientation

• An attempt to explain behavioral genetics in anything but the most limited and global terms; among other things, St. Martin’s was fairly relentless about trimming the science out, and I’m of course no expert

• A manifesto for the idea that environmental influences have no role at all in academic outcomes; some certainly do, but the portion of the variance controllable by teachers and schools appears meager and the high effect influences are mass socioeconomic factors like poverty and racial inequality.

The book is relentlessly focused on ameliorating the damage done to the poor and disenfranchised by our meritocratic system and in standing against our reductive obsession with a narrow set of academic values. But, predictably, it was criticized by many on the left for its suggestion that a half-century of findings in behavioral genetics are correct - that we see a consistent relationship between genetic familial relationships, with those with closer relationships having more similar academic outcomes in a wide variety of academic metrics, while adopted family members are no more similar in those metrics than any two random strangers. We’ve also seen that all manner of attempts to dramatically alter relative educational performance of groups of students have failed again and again, and we’ve seen that over the course of life we become more and more like our parents in terms of our academic outcomes. And we also have the basic knowledge that the brain is built with DNA the same way any of our bodies are, which makes it likely that differences in our genomes influence various aspects of our cognition and learning. (I laid out some of the difficult questions for pure environmentalists here.) Still, objection to any pursuit of this line of thinking is always vociferous, with many claiming that simply scientifically pursuing these questions is itself offensive. Scott Alexander recently wrote about the remarkable lengths some will go to in order to deny that the genes that literally designed our bodies have some say in whether we develop schizophrenia. People think genetic differences are unfair and proceed from there to insist that they are necessarily untrue.

I am aware that I’m not going to change many minds on this issue. But I would ask that you compare the genetic argument to the case for sympathy and support for those children born prematurely. Morally, what is the difference? Why should the claim that academic ability can be negatively impacted by prematurity - or PKU, or bronchopulmonary dysplasia, or Down syndrome, or prenatal infection, or intrauterine hypoxia - be any less offensive? Some of the angrier reactions to the book insisted that I was “saying these kids have no chance.” I am, in fact, arguing that we as a society have a duty to give them (and all of us) a better chance, regardless of the specific hurdles we face, whether disability, racism, sexism, or simply not possessing the kind of skills that are currently valued under neoliberal capitalism. I think the effort to achieve these things through education has demonstrably failed.

But set that aside: how is acknowledging that, say, fragile X syndrome causes significant intellectual impairment any worse than saying that some people have less likelihood of academic success because of their genes? Why would it be more insulting, more unfeeling, more cruel? I don’t understand how saying that some people have less natural academic talent, whatever the origins, can be controversial, but not the acknowledgement that there are some medical conditions that reduce academic potential. Is it the differences in severity? But some cognitive disabilities result in mild but still meaningful impairments. I’m arguing that the physiology and anatomy of the brain has consequences in the classroom. You can certainly dispute whether our genetic endowment influences our academic outcomes. But the idea that considering the question is offensive seems like giving in to vibes to me, seems like avoiding difficult conversations, seems like special pleading provoked by icky feelings.

I have often wondered why environmental influences on academic performance appear somehow more “polite” than genetic, to many people. I think it has something to do with the assumption that they cannot be changed, which again leads to fears of leaving children behind. As committed critics of behavioral genetics often point out, just because a condition is influenced by genetics does not mean that the condition necessarily cannot be changed. But then, the obverse is also true - just because an influence is environmental does not mean it can be changed. The negative academic consequences of lead exposure are persistent, though there are many programs that seek to provide accommodations for those who suffer those consequences. Yet no one who points out that dynamic is accused of wanting to leave the people who suffer that way behind.

Saying that not every child can excel academically is giving up on them only if we insist that academic ability is more important than any other aspect of a human being.

The goal, ultimately, is to undermine our dogged civil commitment to the American ideal that holds that we all control our own destinies, in the classroom or anywhere else. I think most people have an intrinsic sense that it’s wrong for people to suffer under things they can’t control; I think we can’t control how smart we are, for a lot of reasons. The notion that we should provide accommodation and sympathy for people who face challenges they did not create and cannot control is not quite bipartisan but at least intuitive to most. If we are made unequal, not merely rendered unequal by environment or personality or chance, then our duty to provide that accommodation and sympathy only grows. What worries me is that, because a lot of bad people in history have used genetics as a pretext to do bad things, many progressive people prefer to stick their fingers in their ears and refuse to examine the moral consequences of the random (to us) hand we’re all dealt when we’re born. That leaves us disarmed in our efforts to build a more just and equitable world. If the people who usually fight for the victims of chance refuse to engage because talk of genetics makes them squirm, who then will wage that fight?

For decades, politicians and academics and policymakers have insisted that the only way to rescue children from poverty and end various racial gaps is through more and better education. We have become a vastly more educated society in the past half-century, with extraordinary increases in the percentage of Americans with college degrees, master’s degrees, and professional degrees, and a dropout rate that’s miniscule compared to where it once was. Yet the working-age poverty rate stubbornly refused to meaningfully budge. Meanwhile, muscular programs for redistribution such as pandemic aid and major investment in American industry have resulted in the first narrowing of inequality in my lifetime, as modest as that progress may be. If nothing else, perhaps we can stop trying to educate our way out of poverty and inequality. If we do, we can recommit to a humanistic education that values enrichment first, the enrichment of children’s intellectual and emotional lives, while still providing them an opportunity to discover what they like to do, what they’re good at, and what might provide them with a reasonable amount of professional contentment. The nerds at the top will always strive, always hustle. But there’s no reason to force everyone down the same pipe, the college pipe, the job-at-Google pipe, the smart kid life.

I try to sell all of this as a positive when I talk to parents. After all, there’s something very freeing about being able to accept that your kid will be what they will be. Your children will be what they will be. Once you let that wash over you, then you can concentrate your attention on the deeper stuff, the stuff that actually matters, all of the parts of a human being that are just as important or more than how smart we are - our honesty, our courage, our integrity, our compassion, our curiosity, our friendliness, our incredible and endless-multiplying depths. We all have something to contribute; I think, though, that if we’re to build the next more humane era of human society, we can only do so if we are willing to acknowledge that we aren’t all good at the same things. Not just acknowledge it but celebrate it, to be defiant in our insistence on the primacy of core emotional and social values that relate to how we treat others and the kind of fierce commitments we develop within our selves. Parents can help, a little bit at a time, by reminding their kids that there’s more to life than doing well in school, and that no one will remember their GPA when they’re gone, only their capacity for friendship. If I asked you point blank if you would still love your child just as much if you knew they weren’t going to be a good student, you’d say yes. Maybe take time to make sure that they know that, too.

And if you happen to be the parent of a child who was born preterm who has always struggled academically… it’s not your fault, it was never your fault, it’s not your child’s fault either, and there are so many more ways to be a worthwhile human being in this world than just being good at school. Your children will find their thing and you more than anyone else will be the one who will help them find it. The ones who do not enjoy the support of loving parents must then be taken care of by all the rest of us. That’s the only human project.