Why such a severe birthdate bulge?

Most elite athletes begin playing their sports when they are quite young. Since youth sports are organized by age, the leagues naturally impose a cutoff birthdate. The youth soccer leagues in Europe, like many such leagues, use December 31 as the cutoff date.

Imagine now that you coach in a league for seven-year-old boys and are a.s.sessing two players. The first one (his name is Jan) was born on January 1, while the second one (his name is Tomas) was born 364 days later, on December 31. So even though they are both technically seven-year-olds, Jan is a year older than Tomas-which, at this tender age, confers substantial advantages. Jan is likely to be bigger, faster, and more mature than Tomas.

So while you may be seeing maturity rather than raw ability, it doesn't much matter if your goal is to pick the best players for your team. It probably isn't in a coach's interest to play the scrawny younger kid who, if he only had another year of development, might be a star.

And thus the cycle begins. Year after year, the bigger boys like Jan are selected, encouraged, and given feedback and playing time, while boys like Tomas eventually fall away. This "relative-age effect," as it has come to be known, is so strong in many sports that its advantages last all the way through to the professional ranks.

K. Anders Ericsson, an enthusiastic, bearded, and burly Swede, is the ringleader of a merry band of relative-age scholars scattered across the globe. He is now a professor of psychology at Florida State University, where he uses empirical research to learn what share of talent is "natural" and how the rest of it is acquired. His conclusion: the trait we commonly call "raw talent" is vastly overrated. "A lot of people believe there are some inherent limits they were born with," he says. "But there is surprisingly little hard evidence that anyone could attain any kind of exceptional performance without spending a lot of time perfecting it." Or, put another way, expert performers-whether in soccer or piano playing, surgery or computer programming-are nearly always made, not born.*

And yes, just as your grandmother always told you, practice does make perfect. But not just w.i.l.l.y-nilly practice. Mastery arrives through what Ericsson calls "deliberate practice." This entails more than simply playing a C-minor scale a hundred times or hitting tennis serves until your shoulder pops out of its socket. Deliberate practice has three key components: setting specific goals; obtaining immediate feedback; and concentrating as much on technique as on outcome.

The people who become excellent at a given thing aren't necessarily the same ones who seemed to be "gifted" at a young age. This suggests that when it comes to choosing a life path, people should do what they love-yes, your nana told you this too-because if you don't love what you're doing, you are unlikely to work hard enough to get very good at it.

Once you start to look, birthdate bulges are everywhere. Consider the case of Major League Baseball players. Most youth leagues in the United States have a July 31 cutoff date. As it turns out, a U.S.-born boy is roughly 50 percent more likely to make the majors if he is born in August instead of July. Unless you are a big, big believer in astrology, it is hard to argue that someone is 50 percent better at hitting a big-league curveball simply because he is a Leo rather than a Cancer.

But as prevalent as birth effects are, it would be wrong to overemphasize their pull. Birth timing may push a marginal child over the edge, but other forces are far, far more powerful. If you want your child to play Major League Baseball, the most important thing you can do-infinitely more important than timing an August delivery date-is make sure the baby isn't born with two X chromosomes. Now that you've got a son instead of a daughter, you should know about a single factor that makes him eight hundred times more likely to play in the majors than a random boy.

What could possibly have such a mighty influence?

Having a father who also played Major League Baseball. So if your son doesn't make the majors, you have no one to blame but yourself: you should have practiced harder when you were a kid.

Some families produce baseball players. Others produce terrorists.

Conventional wisdom holds that the typical terrorist comes from a poor family and is himself poorly educated. This seems sensible. Children who are born into low-income, low-education families are far more likely than average to become criminals, so wouldn't the same be true for terrorists?

To find out, the economist Alan Krueger combed through a Hezbollah newsletter called Al-Ahd (The Oath) and compiled biographical details on 129 dead shahids (martyrs). He then compared them with men from the same age bracket in the general populace of Lebanon. The terrorists, he found, were less likely to come from a poor family (28 percent versus 33 percent) and more likely to have at least a high-school education (47 percent versus 38 percent).

A similar a.n.a.lysis of Palestinian suicide bombers by Claude Berrebi found that only 16 percent came from impoverished families, versus more than 30 percent of male Palestinians overall. More than 60 percent of the bombers, meanwhile, had gone beyond high school, versus 15 percent of the populace.

In general, Krueger found, "terrorists tend to be drawn from well-educated, middle-cla.s.s or high-income families." Despite a few exceptions-the Irish Republican Army and perhaps the Tamil Tigers of Sri Lanka (there isn't enough evidence to say)-the trend holds true around the world, from Latin American terrorist groups to the al Qaeda members who carried out the September 11 attacks in the United States.

How can this be explained?

It may be that when you're hungry, you've got better things to worry about than blowing yourself up. It may be that terrorist leaders place a high value on competence, since a terrorist attack requires more orchestration than a typical crime.

Furthermore, as Krueger points out, crime is primarily driven by personal gain, whereas terrorism is fundamentally a political act. In his a.n.a.lysis, the kind of person most likely to become a terrorist is similar to the kind of person most likely to...vote. Think of terrorism as civic pa.s.sion on steroids.

Anyone who has read some history will recognize that Krueger's terrorist profile sounds quite a bit like the typical revolutionary. Fidel Castro and Che Guevara, Ho Chi Minh, Mohandas Gandhi, Leon Trotsky and Vladimir Lenin, Simon Bolivar, and Maximilien Robespierre-you won't find a single lower-cla.s.s, uneducated lad among them.

But a revolutionary and a terrorist have different goals. Revolutionaries want to overthrow and replace a government. Terrorists want to-well, it isn't always clear. As one sociologist puts it, they might wish to remake the world in their own dystopian image; religious terrorists may want to cripple the secular inst.i.tutions they despise. Krueger cites more than one hundred different scholarly definitions of terrorism. "At a conference in 2002," he writes, "foreign ministers from over 50 Islamic states agreed to condemn terrorism but could not agree on a definition of what it was that they had condemned."

What makes terrorism particularly maddening is that killing isn't even the main point. Rather, it is a means by which to scare the pants off the living and fracture their normal lives. Terrorism is therefore devilishly efficient, exerting far more leverage than an equal amount of non-terrorist violence.

In October 2002, the Washington, D.C., metropolitan area experienced fifty murders, a fairly typical number. But ten of these murders were different. Rather than the typical domestic disputes or gang killings, these were random and inexplicable shootings. Ordinary people minding their own business were shot while pumping gas or leaving the store or mowing the lawn. After the first few killings, panic set in. As they continued, the region was virtually paralyzed. Schools were closed, outdoor events canceled, and many people wouldn't leave their homes at all.

What kind of sophisticated and well-funded organization had wrought such terror?

Just two people, it turned out: a forty-one-year-old man and his teenage accomplice, firing a Bushmaster .223-caliber rifle from an old Chevy sedan, its roomy trunk converted into a sniper's nest. So simple, so cheap, and so effective: that is the leverage of terror. Imagine that the nineteen hijackers from September 11, rather than going to the trouble of hijacking airplanes and flying them into buildings, had instead spread themselves around the country, nineteen men with nineteen rifles in nineteen cars, each of them driving to a new spot every day and shooting random people at gas stations and schools and restaurants. Had the nineteen of them synchronized their actions, they would have effectively set off a nationwide time bomb every day. They would have been hard to catch, and even if one of them was caught, the other eighteen would carry on. The entire country would have been brought to its knees.

Terrorism is effective because it imposes costs on everyone, not just its direct victims. The most substantial of these indirect costs is fear of a future attack, even though such fear is grossly misplaced. The probability that an average American will die in a given year from a terrorist attack is roughly 1 in 5 million; he is 575 times more likely to commit suicide.

Consider the less obvious costs, too, like the loss of time and liberty. Think about the last time you went through an airport security line and were forced to remove your shoes, shuffle through the metal detector in stocking feet, and then hobble about while gathering up your belongings.

The beauty of terrorism-if you're a terrorist-is that you can succeed even by failing. We perform this shoe routine thanks to a b.u.mbling British national named Richard Reid, who, even though he couldn't ignite his shoe bomb, exacted a huge price. Let's say it takes an average of one minute to remove and replace your shoes in the airport security line. In the United States alone, this procedure happens roughly 560 million times per year. Five hundred and sixty million minutes equals more than 1,065 years-which, divided by 77.8 years (the average U.S. life expectancy at birth), yields a total of nearly 14 person-lives. So even though Richard Reid failed to kill a single person, he levied a tax that is the time equivalent of 14 lives per year.

The direct costs of the September 11 attacks were ma.s.sive-nearly three thousand lives and economic losses as high as $300 billion-as were the costs of the wars in Afghanistan and Iraq that the United States launched in response. But consider the collateral costs as well. In just the three months following the attacks, there were one thousand extra traffic deaths in the United States. Why?

One contributing factor is that people stopped flying and drove instead. Per mile, driving is much more dangerous than flying. Interestingly, however, the data show that most of these extra traffic deaths occurred not on interstates but on local roads, and they were concentrated in the Northeast, close to the terrorist attacks. Furthermore, these fatalities were more likely than usual to involve drunken and reckless driving. These facts, along with myriad psychological studies of terrorism's aftereffects, suggest that the September 11 attacks led to a spike in alcohol abuse and post-traumatic stress that translated into, among other things, extra driving deaths.

Such trickle-down effects are nearly endless. Thousands of foreign-born university students and professors were kept out of the United States because of new visa restrictions after the September 11 attacks. At least 140 U.S. corporations exploited the ensuing stock-market decline by illegally backdating stock options. In New York City, so many police resources were shifted to terrorism that other areas-the Cold Case Squad, for one, as well as anti-Mafia units-were neglected. A similar pattern was repeated on the national level. Money and manpower that otherwise would have been spent chasing financial scoundrels were instead diverted to chasing terrorists-perhaps contributing to, or at least exacerbating, the recent financial meltdown.

Not all of the September 11 aftereffects were harmful. Thanks to decreased airline traffic, influenza-which travels well on planes-was slower to spread and less dangerous. In Washington, D.C., crime fell whenever the federal terror-alert level went up (thanks to extra police flooding the city). And an increase in border security was a boon to some California farmers-who, as Mexican and Canadian imports declined, grew and sold so much marijuana that it became one of the state's most valuable crops.

When one of the four airplanes hijacked on September 11 crashed into the Pentagon, all of the seriously injured victims, most of whom suffered burns, were taken to Washington Hospital Center, the largest hospital in the city. There were only a handful of patients-corpses were more plentiful-but even so, the burn unit was nearly overwhelmed. Like most hospitals, WHC routinely operated at about 95 percent of capacity, so even a small surge of patients stressed the system. Worse yet, the hospital's phone lines went down, as did local cell service, so anyone needing to make a call had to jump in a car and drive a few miles away.

All things considered, WHC performed well. But for Craig Feied (p.r.o.nounced FEE-ed), an emergency-medicine specialist there, the incident confirmed his greatest fears. If the hospital nearly went haywire with just a few extra burn patients, what would happen during a major disaster, when the ER was most needed?

Even before September 11, Feied had spent thousands of hours thinking such grim thoughts. He was the chief architect of a federally funded pilot program called ER One, which was meant to drag the emergency room into the modern era.

Until the 1960s, hospitals simply weren't designed to treat emergencies. "If you brought someone to a hospital at night," Feied says, "the doors would be locked. You'd ring the bell, a nurse would come down to see what you wanted. She might let you in, then she'd call the doctor at home, and he might or might not come in." Ambulances were often run by the local mortuary. It is hard to think of a better example of misaligned incentives: a funeral director who is put in charge of helping a patient not die!

Today, emergency medicine ranks as the seventh-largest physician specialty (out of thirty-eight), with a fivefold increase in pract.i.tioners since 1980. It is a master-of-all-trades endeavor, performed at lightning speed, and the emergency room has become the linchpin of public health. In a given year, there are roughly 115 million ER visits in the United States. Excluding pregnancies, 56 percent of all people admitted to U.S. hospitals come through the ER, up from 46 percent in 1993. And yet, Feied says, "you could drive a truck through the gaps in our protocols."

September 11 brought home the point that emergency rooms are painfully limited in their surge capacity. If there had been a thousand victims at WHC, would they even have gotten inside?

Such a prospect makes Feied grimace. Most ERs have an ambulance bay that can fit only a few vehicles at a time. The docks are also built too high-"because the people who designed them were used to building loading docks," Feied says. Rooftop helipads are similarly problematic because of the time and s.p.a.ce constraints of a single elevator. Feied's idea for getting rid of such bottlenecks is to design an ER more like an airport, with a large convex intake area that could accommodate a mult.i.tude of ambulances, buses, or even helicopters.

But these intake issues aren't what worry Feied the most. A hospital that gets. .h.i.t with something serious and communicable-SARS or anthrax or Ebola or a new strain of lethal influenza-would soon cripple itself. Like most buildings, hospitals recirculate their air, which means that one sick patient could infect hundreds. "You don't want to go to the hospital for a broken ankle and get SARS," Feied says.

The answer is to build hospitals, and especially ERs, with rooms designed for isolation and zero air recirculation. But most hospitals, Feied notes, don't want to spend money on such uns.e.xy, non-revenue-generating features. "There were some nice emergency departments built in 2001, state-of-the-art, and they're completely obsolete today. They were built with open bays, divided by curtains, but if you have a SARS patient in Bed 4, there's not a patient or doctor in the world who will want to go into Bed 5."

And don't even get Feied started on all the hospital patients who die from a cause other than what brought them to the hospital: wrong diagnoses (the result of carelessness, hubris, or cognitive bias); medication errors (based, far too often, on sloppy handwriting); technical complications (reading an X-ray backward, for instance); and bacterial infections (the deadliest and most pervasive problem).

"The state of current medical practice is so bad right now that there's not very much worth protecting about the old ways of doing things," Feied says. "n.o.body in medicine wants to admit this but it's the truth."

Feied grew up in Berkeley, California, during the very raucous 1960s, and he fit right in. He skateboarded everywhere; he occasionally jammed on drums with a local band called the Grateful Dead. He had an apt.i.tude for mechanics, taking apart and rea.s.sembling whatever looked interesting, and he was enterprising: by eighteen, he had founded a small technology company. He studied biophysics and mathematics before going into medicine. He became a doctor, he says, because of "the lure of secret knowledge," a desire to understand the human body as well as he understood machines.

Still, you sense that machines remain his first love. He is a fervent early adopter-he put a fax machine in the ER and started riding a Segway when both were novelties-and he excitedly recalls hearing a lecture by the computer scientist Alan Kay more than thirty-five years ago on object-oriented programming. Kay's idea-to encapsulate each chunk of code with logic that enabled it to interact with any other piece-was a miracle of streamlining, making programmers' lives easier and helping turn computers into more robust and flexible tools.

Feied arrived at Washington Hospital Center in 1995, recruited by his longtime colleague Mark Smith to help fix its emergency department. (Smith was also a true believer in technology. He had a master's degree in computer science from Stanford, where his thesis adviser was none other than Alan Kay.) Although some of WHC's specialty departments were well regarded, the ER consistently ranked last in the D.C. area. It was crowded, slow, and disorganized; it ran through a new director every year or so, and the hospital's own medical director called the ER "a pretty undesirable place."