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What can genetics tell us about the possibilities of early intervention?

Reflections from #EIFNatCon

Reflections from three attendees at this session at our 2016 national conference.

The session was introduced by EIF’s Director of Evidence Professor Leon Feinstein and chaired by Professor Anna Vignoles of Cambridge University. The panel was made up of EIF Research Officer and Sussex PhD student Rachel Latham, Professor Yulia Kovas of Goldsmith’s, University of London, and Gabriella Conti, Associate Professor at UCL.

Duncan Tessier, Assistant Director of Early Intervention & Prevention, Children’s Services, Barnet Council

In this breakout session we were in distinguished company, with a panel containing world leading experts from across the fields of economics, education, genetics and psychology.

The session started with Professor Leon Feinstein posing a big question: we know that around £17bn per annum of government spending focuses on the dealing with the financial costs of ‘late intervention’- such as family breakdown, mental health and domestic violence services. But what percentage of that £17bn is actually preventable in a (theoretical) world where we got early intervention ‘exactly right’? Part of the answer could in turn depend on the extent to which genetics determines outcomes. If poor outcomes are pre-determined by our genes, then might that limit the effectiveness of early intervention?

To unpick the answer, we heard first from Rachel Latham who defined the key concept of ‘heritability’ – which describes the proportion of attributes (e.g. height / weight / personality) within a given population which are determined by genes, versus all other factors (such as income, education, parenting environment). She explained that 80% of the difference between the tallest and shortest in a population will tend to be explained by difference in genes, and only around 20% by environment and experience.

Professor Yulia Kovas set out how the study of heritability was already showing some striking insights. For example, the heritability of education attainment is much greater in the UK than the US – meaning that a population’s inherent intelligence is more important in determining educational outcomes in the UK compared to the US. This is because heritability depends on the environments in which the population is situated. If everyone is exposed to a similar environment, then any differences we observe will largely be due to genes; if the environment varies significant, then heritability may be small. Research has hypothesised that the presence of the national curriculum in the UK ensures more uniformity of standards in education in the UK, increasing heritability. By contrast, in the US, where there is a larger variance in education standards, there is lower heritability.

Standard policy thinking would be that observing variance in outcomes for educational attainment may be a sign of inequality of opportunity. Heritability research suggests a counter-intuitive conclusion: observing difference in educational attainment within a population could in fact be a sign of effective government intervention, as it could mean environmental barriers (such as poverty) – which can have the effect of suppressing genetic differences – have been removed.

Professor Kovas described the field of molecular genetics as “the fastest growing area of human endeavour”, which could have wide reaching implications for social policy. For example Gabriella Conti of UCL discussed how – if we can develop an understanding of which genes drive poor outcomes – we might tailor our interventions differently to genetically ‘at risk’ groups (in the same way as we do already with teenage parents or low income groups). The Panel discussed how whilst this academic work is in its infancy, we need to think through now the ‘bio-ethical’ implications of unlocking this kind of genetic understanding.

The session demonstrated that the question of whether outcomes for people are driven by ‘nature or nurture’ is too simplistic. There is clearly an inter-play, with environments influencing the extent to which a person’s genes affect their outcomes.

Overall, it will be important for those interested in early intervention to follow this evolving field, as it could provide insights into both how to better target early interventions, and how to influence the environment in a way that supports peoples’ genetic endowments.

That feels a good way to view progress in early intervention and parenting policy. And if this is how far things have come, we have great foundations to build on for the future.

Ruth Rothman, Head of Clinical Implementation & Education, Family Nurse Partnership National Unit

Well, what a workshop. The discussion about genetics, heritability, behavioural and epigenetics served to stimulate my neurons and raised so many questions.

Is heritability (a population measure) important in early intervention? Can an intervention alter life’s trajectory? And even could genetic screening eventually guide our interventions?

The debate in the room was helpful, interesting and stretching. What I took away was that babies are born with a particular genetic makeup, determined by their parent’s genes. These genes play a role in influencing many characteristics. Genes explain between 50 to 80% of an individual’s characteristics.  Not only is the environment important in shaping some outcomes, but also plays a role in influencing which genes are expressed.  This process is known as epigenetics and is in its infancy but could have important information in the near future to guide clinicians’ work with infants and families.

As clinicians we owe it to ourselves to link with the important world of molecular genetics, the fastest growing science in the history of science, as it seems that this world is ever changing and could have a great influence on early intervention in the coming years.

Vivette Glover, Professor of Perinatal Psychobiology, Imperial College London

This part of the National Conference of the Early Intervention Foundation was really well attended. It was great to have policemen, commissioners, people from local councils, and charities all so interested in whether our genes are so determinant of how we turn out that intervention may not help much.

Leon Feinstein in his introduction, said that he had been asked, how much can early intervention really do? This made him want to consider the role of genetics further, and thus this session.

The speakers all made clear that the fact that genetics does contribute to many of the traits the Foundation wants to help with, such as aggression or mathematical ability, does not imply that the environment and intervention are not very important too. Rachel Latham explained that measures of heritability, for features such as height or IQ, do not tell us the relative contribution of genes and environment in a particular individual. Heritability tells us about the relative contribution of genes and environment in a population.

Yulia Kovas explained that if the environment is more constant then the heritability contribution will be greater. For example heritability for educational achievement is greater in the UK than the USA, but she attributed this, not to a difference in the gene pools, but to the national curriculum and less inequality in the teaching environment in the UK.

Gabriella Conti made the point that even if a feature is very largely genetic in cause, that does not mean that intervention cannot be beneficial. Even if short sight were entirely genetic, we would still want to provide glasses.

There was much engagement from the audience in the discussion. The issues of ethics and public perception were raised. Were there links with eugenics? Gabriella Conti said that in medicine, including cancer, some treatment is now personalised; and certain drugs or treatments are more effective in people with a specific genetic make up. Everyone thinks this is acceptable, and maybe we could draw on this analogy for social interventions too. However the genetic components of traits such as aggression are very complex, and probably hundreds of genes contribute, each having a small effect. The speakers emphasised that, although one day we may be in a position to target specific social interventions towards individuals with a particular genetic makeup, our knowledge does not allow us to do that yet.