An Economist says to Physicians: you don't know your data!

[My wife is a physician-PhD, so I doubt I am an impartial observer here.--ES]

In reality, medical care during pregnancy seemed to be one long list of rules. Being pregnant was a good deal like being a child again. There was always someone telling me what to do, but the recommendations from books and medical associations were vague and sometimes contradictory. It started right away. "You can only have two cups of coffee a day." I wondered why. What did the numbers say about how risky one, two or three cups were? This wasn't discussed anywhere.

The key to good decision making is evaluating the available information—the data—and combining it with your own estimates of pluses and minuses. As an economist, I do this every day. It turns out, however, that this kind of training isn't really done much in medical schools. Medical school tends to focus much more, appropriately, on the mechanics of being a doctor--Emily Oster in WSJ [HT Diana Weinert Thomas via Facebook].

Oster's editorial is a pre-publication to a commercial book. It's supposed to be provocative. Indeed, it 'ticks off' all the 'right boxes:' babies, a desire for self-ownership/autonomy ("Pregnant women...want to assess risks for themselves and make their own best decisions"), rejects scientific over-reach ("fuzzy science and half-baked research"), embraces the good life ("a glass of wine every now and then, plenty of coffee, exercise when I wanted it") etc. Her editorial also offers a glimpse into the eugenic ideals of the new epistemic elite: "the other big concern with alcohol [consumption during pregnancy] is low IQ" of the child. (Fetal alcohol syndrom is not just about IQ.) 

Oster is a famous economist, who is very aware of the limitations of data: her most cited paper -- a criticism of A. Sen -- is this one, which she later partially corrected with this one. It is great that she calls attention to how many of the norms promoted by medical experts are often based on rather thin evidential basis (two decades into the evidence-based-medicine rage). That she does so by exhibiting the now-classic-superiority-complex-of-the-Harvard-trained-economist [see here]-- she "knew enough to read the numbers correctly" --  at the expense of the medical types ("this kind of training isn't really done much in medical schools") is, shall we say, not very classy. (For the record: all the human sciences have recurring problems with opportunistic data-analysis.)

Let's hope that Oster's book actually does what economist do best: examine incentives. What we really need is a critical, data-driven analysis of the institutions and incentives that allow norms be propagated by bio-medical-pharmaceutical-governmental establishments even when founded on not-so-firm evidential basis. As Oster notes these norms make "Being pregnant...a good deal like being a child again;" this suggests that the crucial issue(s) here is not so much flimsy-data. Here's a hypothesis: what makes these paternalistic (sometimes promoted by female physicians) norms 'functional' is living sexism.