Biological luck - I

People are obsessed with finding out the secrets to success. Many take great pride in describing themselves as self-made. They will assert that it was their individual traits — talent, skill, mental toughness, work ethic, persistence, optimism, etc. that helped them reach where they are now. Parents keep telling their children that if they try hard enough, they can achieve their goals. Self-help books will keep telling you that you, alone, are the solution that you seek. They ignore the fact that their success was entirely due to the initial conditions that they found themselves in which benefited them greatly.  

It is difficult to see that society's wealthiest and most successful individuals are simply the lucky ones. I had thought luck was important but not to the extent that I now think it is. How important the luck you had in where and to whom you were born only recently became clear to me after reading and listening to Robert Sapolsky who teaches neuroscience at Stanford University. The genes you inherited, foetal environment, childhood experience, the culture you were born in, all contributed to shaping the construction of your brain. 

Choices, efforts, intentions, will power, all of which influence our behaviour, are themselves biological phenomena. You are lucky to have them. Basically, our present state is the result of our cumulative biological and environmental luck. A misguided notion that many have today is spelled out by the nihilist, Bazarov, in Ivan Turgenev's Fathers and Sons: 

I assure you, studying separate individuals is not worth the trouble. All people are like one another, in soul as in body; each of us has brain, spleen, heart, and lungs made alike; and the so–called moral qualities are the same in all; the slight variations are of no importance. A single human specimen is sufficient to judge of all by. People are like trees in a forest; no botanist would think of studying each individual birch–tree.

Most people will agree that our natural attributes like height, which make you good at playing certain games, or fast twitch fibres, that enable you to run fast, are biological. Then they will say that what really matters is what do you do with those attributes - whether you work hard to take advantage of those gifts or whether you waste these blessings. But this ability to work hard doesn’t come out of thin air. It's that brain of yours (and more specifically, a part of the brain called the frontal cortex) that decides if you are going to show impulse control or whether you give in to the slightest temptation. 

The frontal cortex is the most recently evolved brain region. The human frontal cortex is bigger and more complex than in other apes. It has a wide portfolio of functions including working memory, gratification postponement, long-term planning, regulation of emotions, impulse control, among others. Sapolsky groups these functions under one heading: "the frontal cortex makes you do the harder thing when it’s the right thing to do." It is the last brain region to fully mature, with people being in their mid-twenties by the time it is fully functional. 

The frontal cortex, and even more specifically, a part of it known as the pre-frontal cortex (PFC), is critical for making tough decisions in the face of temptation. This explains why teenagers do things that adults find daft - their PFC is not yet firing on all cylinders. And everyone doesn’t have the same PFC (and other parts of the brain). The enormous varieties of adolescent experiences will help produce enormously varied PFCs in adulthood. And this PFC is responsible for what you characterise as grit, character, backbone, tenacity, strong moral compass, etc.

Your adolescent experiences of trauma, stimulation, love, failure, rejection, happiness, despair, etc. all have played a very important role in constructing the PFC that you are using as an adult to decide whether to practice now or to skip it and watch a movie instead. It is difficult to appreciate that the same neurotransmitters, receptors, or transcription factors are involved when considering feats of willpower as is the case when regarding fast twitch fibers. Most people seem to have to have no idea how lucky one must be to be both talented and hard working. Your admirable self-discipline has much to do with how your cortex was constructed when you were a foetus and your childhood and adolescence.

You can’t will yourself to have more willpower. The factors that can affect willpower include blood glucose levels; the socioeconomic status of your family of birth; sleep quality and quantity; prenatal environment; stress; whether you’re in pain; if you have had a stroke in your frontal cortex; if you suffered childhood abuse; how much of a cognitive load you’ve borne in the last few minutes; if you’re infected with a particular parasite; if you have the gene for Huntington’s disease; lead levels in your tap water when you were a kid; if you live in an individualist or a collectivist culture, among many others, most of which are beyond your control.

Blood glucose levels affect willpower because of the glucose demands of the frontal cortex. A real- world example of this is a study of more than 1,100 judicial rulings. What best predicted whether a judge granted someone parole versus more jail time? It was found that the longer it had been since judges had eaten, the less likely they were to grant a prisoner parole. There was overall decline over the course of a tiring day with essentially a zero percent rate just before judges ate. This shows that there are situations when biology can affect our behaviour. 

What was causing this behaviour? As the hours since the last meal kept increasing, the PFC was finding it more difficult to focus on the details of each case, the judge became more likely to choose the easier default option which is to send the person back to jail. This is the easier option than giving careful thought to whether the criminal in front of you has some potential for change. This idea is supported by a study in which subjects had to make judgments of increasing complexity. As the task progressed, the PFC became more slow during deliberating and the subjects became more likely to opt for the easier decision. Of course judges will give various philosophical reasons for rationalizing their decisions rather than say that they were caused by hunger. 

Ignaz Semmelweis

Ignaz Semmelweis was born in Budapest in 1818. He received his doctor’s degree from Vienna in 1844 and was appointed assistant at the obstetric clinic in Vienna and devoted his life to the health of babies and mothers. His is a name you have probably never heard of. He has probably saved more lives than any other person in the medical profession. 

Rich women delivered at home. But poverty, illegitimacy, or obstetrical complications forced many woman to seek hospitalization. The mortality rates ranged as high as 25–30 percent. Various ideas were floated to explain the high death rates. Some thought that the infection was induced by overcrowding, poor ventilation, the onset of lactation, or miasma. Semmelweis too proceeded to investigate its cause although his chief objected because he thought that the deaths could not be prevented. 

Semmelweis started observing hospital routines. He noted that pregnant women were admitted to one of two obstetric wards. The only difference between the two wards was that one was staffed exclusively by midwives, while in the other ward, medical students and doctors were in charge of deliveries and conducted autopsies on dead women in the nearby room. He observed that mortality was much higher in the latter ward. 

The death of a friend and colleague of Semmelweis provided him a clue to solve this puzzle. The friend developed a condition resembling the fever in the obstetrics ward staffed by doctors following a scalpel laceration while supervising an autopsy. This made him suspect that the higher mortality rate in the ward was due to the contamination of the hands of medical students and doctors with something during autopsies. He began to suspect that doctors were bringing the infection to the patients. 

The idea that many diseases are caused by germs is only about 150 years old. In Sommelweis' time, doctors often went directly from dissecting corpses in the morgue to examining mothers in the maternity ward. He suggested as an experiment that the doctors wash their hands before touching the mothers not just with soap but with a chlorine solution. Chlorine, as we know today, is about the best disinfectant there is. Semmelweis didn't know anything about germs. He chose chlorine because he thought it would be the best way to get rid of any smell left behind by those little bits of corpse on the doctors' hands.

And when he imposed this, the rate of childbed fever fell dramatically. You'd think everyone would be thrilled. Semmelweis had solved the problem! But they weren't thrilled. For one thing, doctors were upset because Semmelweis' hypothesis made it look like they were the ones giving childbed fever to the women. How dare he make such a suggestion to his social superiors? He was a nobody who kept on asking his colleagues to wash their hands. And Semmelweis was not very tactful. He publicly berated people who disagreed with him and made some influential enemies. Eventually the doctors in his clinic refused to listen to him and gave up the chlorine hand-washing. He lost his job.

Semmelweis kept trying to convince doctors in other parts of Europe to wash with chlorine, but no one would listen to him. At the time, it was argued that diseases resulted from imbalances among four humors, and that each disease was unique because each person was unique. Doctors said that a healthy person had a perfect balance of the four humors of black bile, yellow bile, phlegm, and blood. Semmelweis's findings that disease resulted from unhygienic practices contrasted with the theory of humors. Historians have argued that Semmelweis's Jewish and Hungarian origins contributed to the dismissal.

Without a job, Semmelweis left Vienna and returned to Pest, Hungary. There, he continued to implement his hand washing procedures. In 1851, He became the head physician at the Szent Rókus Hospital in Pest. When he implemented his policies, the rate of childhood fever plummeted. In 1855, Semmelweis became head of obstetrics at the University of Pest. When he implemented the chlorine washing procedure, infection rates at the university hospital fell. Throughout the 1850s, Semmelweis wrote papers on childhood fever and, in 1861, he published his book on the subject. 

Semmelweis's mental health began to deteriorate after the publication of his book and he suffered from severe depression. By 1865, his abnormal public behavior started affecting his professional life and his wife and some of his colleagues committed him to an insane asylum in Vienna, Austria. After trying to leave the insane asylum in August 1865, he was beaten and put in a straitjacket. After two weeks in the asylum, Semmelweis died on 13 August 1865 in Vienna, Austria. His autopsy revealed that he had died from blood poisoning in a wound that could have been sustained during the beating.

Semmelweis’s doctrine was subsequently accepted by medical science. Semmelweis was a pioneer in scientific risk assessment and in identifying the source of transmission, including conducting an effective intervention. Subsequently, it might be said that he has saved millions of lives, including, quite possibly, yours and mine.