I’ve been reading Emily Oster’s Expecting Better, a book which is notable on Amazon for having essentially nothing but 1 or 5 star reviews. The template for the 1 star reviews is “Oh my god, Oster is promoting fetal alcohol syndrome,” and the template for the 5 star reviews is, “Jesus christ people.”
For those not in the know, Oster is an economist who, when she was pregnant, decided to review medical literature and see how many of the pregnancy dictums she was being exposed to were backed up by available evidence, and how many weren’t. By far the most controversial thing that she decided was that having about a single drink a day in the 2nd and 3rd trimesters, and a drink or two per week in the 1st trimester, is just fine.
It’s a little sad that this has become the defining feature of the book, both because if you were paying attention, you already knew that light drinking during pregnancy was not a big problem, and also because there’s a lot more of the book than that. Oster’s writing style is engaging, full of reassuring, clear explanations punctuated by a nicely dry and self-deprecating sense of humor — a recent passage I read mentioned Oster’s momentary panic over not having felt her child move in a few hours being assuaged by “experiencing the reassurance of someone punching me as hard as she could in my bladder.” Readers of, say, this blog may find that some of her patient explanation of pretty elementary statistical material is somewhat remedial, but that’s easily skimmed past. And the rest of the book is a really good overview of what is and isn’t behind a lot of the pregnancy common wisdom.
But the alcohol thing is definitely where all the heat and light is. And I think it demonstrates a more fundamental issue. The people who are up in arms about drinking a bit of wine during pregnancy are at heart, I believe, expressing a desire for simple rules, and an abhorrence of cost/benefit analysis. Expecting Better is, more than pregnancy book, a microeconomics book. You might come away from it remembering little about any specific pregnancy fact, but it will be impossible to come away from it without understanding Oster’s framework for understanding the world and making decisions, which is:
- You ignore the hell out of folk wisdom.
- You look at published empirical data, critically, with an eye towards “does this really hold up.”
- From the data, you establish what the costs or risks are to you preferred option.
- You decide whether those costs or risks are sufficient for you.
Which probably doesn’t come as a huge surprise to anyone who reads a technology-and-economics focused blog, but is not how a lot of people make a lot of decisions (probably those people include both you and me, and likely Oster, for at least some decisions). And indeed, the reason why we have to have closely controlled studies that correct for bias is that on some level, it’s not “natural” to think this way. That is, you’re set up to make snap judgments according to some kind of framework of rules, not to constantly weigh cost and benefit. I think that people find systems of rules comforting. They externalize responsibility. If my doctor says, “No drinking during pregnancy,” then, well, first, I’ll get another doctor because my doctor should realize I’m a dude. But second, I don’t own any negative consequences of my actions. The doctor does. That’s comforting.
I think that’s what’s drawing people to hate on Oster so virulently.
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