An economist's perspective on the rules of pregnancy

[urbancowgirl]

I thought this WSJ article was interesting and thought I would share.

online.wsj.com/article/SB10001424127887323514404578652091268307904.html?mod=e2tw

[sonrisa]

She is missing a big point there. (Doctors have plenty of training in statistics and probabilities (contrary to what she asserts)). In most of medicine, they run double blind control studies. Then you have the stats she wants. For the type of issues she discusses, a double blind study is often impossible or unethical. Assigning a group of women to regularly drink wine in a double blind study would be almost tuskgee like in it's implications. (After all, there are known risks at some level of consumption. Trying to determine where exactly that line lies through something other than self report studies would put fetuses at risk and they can't consent). 

In short, I'm rolling my eyes at her. Sure, I'd love to have probability stats on this stuff. Getting those stats would be unethical.

[winecheery]

Huh. Yeah....

I know not everyone has it but I have found common sense and personal belief system to work in my favor so far. I guess it helps my personal belief system does not involve throwing caution entirely to the wind and drinking like it's New Year's Eve while I'm KU but...that's kind of my philosophy on this whole thing, for good or bad.

And sonrisa has a good point in that the odds of getting accurate data does inevitably put someone's fetus at some risk (at least) and so you'll never get a real answer as to how far is too far.

ETA  I see at the end of the article she made a statement that implies she was using her own common sense to make her choices, so I guess even that can't be a barometer for what's "wrong or right".  It's more of a "what works for you" kind of thing I suppose.  I guess my earlier point was more to do with the "pregnant women clamoring for more information", because yeah, that's not going to happen in the way she is describing/hoping.

[MrsAxilla]

Aug 12, 2013 11:20:07 GMT -5 sonrisa said:

She is missing a big point there. Doctors have plenty of training in statistics and probabilities (contrary to what she asserts). 

Not really.  Docs who go the research route do, of course.  But a regular run of the mill med student doesn't get a lot of training in stats.  

By the way, a friend of a Facebook friend has the same avatar as you.  Weird!

[sonrisa]

Aug 12, 2013 11:48:17 GMT -5 MrsAxilla said:

Aug 12, 2013 11:20:07 GMT -5 sonrisa said:

She is missing a big point there. Doctors have plenty of training in statistics and probabilities (contrary to what she asserts). 

Not really.  Docs who go the research route do, of course.  But a regular run of the mill med student doesn't get a lot of training in stats.  

By the way, a friend of a Facebook friend has the same avatar as you.  Weird!

Really? Maybe that depends on the med school? DH is pretty well steeped in stats. He used to teach it at Cal, but that was before he went to med school and he has done a decent amount of research. I assumed it was a premed basic requirement. It comes up all the time in their course work and practice.  I'm surprised it isn't required. 

Funny about the ostrich. My facebook avatar is different :-)

ETA: Google tells me very few med schools require stats. That is so weird. I take back what I said above about stats training. Apparently, it isn't required even though it is a big part of understanding med research. And understanding med research is a skill they need. So odd.

[MrsAxilla]

Aug 12, 2013 11:57:42 GMT -5 sonrisa said:

Aug 12, 2013 11:48:17 GMT -5 MrsAxilla said:

Not really.  Docs who go the research route do, of course.  But a regular run of the mill med student doesn't get a lot of training in stats.  

By the way, a friend of a Facebook friend has the same avatar as you.  Weird!

Really? Maybe that depends on the med school? DH is pretty well steeped in stats. He used to teach it at Cal, but that was before he went to med school and he has done a decent amount of research. I assumed it was a premed basic requirement. It comes up all the time in their course work and practice.  I'm surprised it isn't required. 

Funny about the ostrich. My facebook avatar is different :-)

ETA: Google tells me that UCLA is the only med school that requires stats. That is so weird. I take back what I said above about stats training. Apparently, it isn't required even though it is a big part of understanding med research. And understanding med research is a skill they need. So odd.

I don't think stats is required to get into med school, either. I suppose some undergrad programs require it, but when I was in college, stats was the 'easy' math class for math idiots. (I took it. Twice. Lol!)

[sent]

Biology follows some rules but has lots of variability and deviation from those rules. It's not a cut and dry field like economics.

So what happens if we follow all the rules and still get an untoward event? In the US, we like to sue every person that ever touched our medical charts. Hence every patient is treated like a potential lawsuit. No wonder American doctors would never say "a glass of wine once in a while might be fine." Because we don't know the exact limit of "alcohol won't hurt the baby" versus "alcohol will hurt the baby." So safer to say "No alcohol" than to leave any gray area out there that could be used against the doctor in a lawsuit. Australian doctors probably don't face such scrutinity or lawsuits over there so they don't worry as much if their responsible patients have a glass of wine or not.

[magpie]

I actually quite enjoyed the article. When I first got pregnant, I tried to look at some of the research on drinking and caffeine in pregnancy and was frustrated by the lack of good research in both areas. I am a librarian (who used to be a science librarian/worked in a biomedical library) and my H does biomedical research, so it is our instinct to research and read medical studies, rather than solely ask the doctor, whenever we have health questions. I totally understand that it isn't ethical (and would never be human subjects approved!) to recommend to pregnant women in the US to drink a little, so we can see what it does, but there are different recommendations in different countries, so it seems like good research should be possible. I don't know. I wish that there were better studies and hard statistics to support the recommendations made, so I can identify with a lot of the frustration in the author's article. I do get that conducting the research is extremely difficult though. I felt the same way while TTC too. Everyone is all drink Pom juice and eat pineapple, but there's no research supporting anything like that.

I try to play it conservatively, for the most part, but yeah, it is kind of arbitrary to say that I will drink one watered down cup of coffee per day, avoid alcohol completely for the most part (I had a few sips of beer yesterday!), and only eat pasteurized cheeses (even though the last listeria outbreak was caused by cheese that was pasteurized).

[Cheesecake]

sent 's point is what I love about medical care in NL. Yhis country doesn't do law suits really, and definitely not at doctors (unless maybe.they're obviously perdorming surgeries drunk off their ass and they've effed up and killed a bunch of people.

The fact that it's nearly impossible to sue a.doctor makes the doctor treat ypu like a human being, a patient and cater to the specifics of each person.
When I asked my doctor if and how much alcohol os okay, he said, honestly, "I don't know". He then recommended a book for us to read and choose for ourselves if and how much alcohol we'd be okay with. Same doc to a friend of a friend of mine.said 'no more than 1 glass a week' because he knew she wasn't interested in researching stuff herself, wanted clear rules and with her lifestyle she'd do better drinking an occasional glass than having strict no-alcohol-rules forced upon her.
This is at the same hospital where a doc (not mine) actually told a friend to keep smoking (but only 4 cigs a day) because with her body's response to.quitting the streas, blood pressure and all those fun things were worse for the baby than the nicotine and stuff would be. He did tell her that she had to quit smoking right after she delivered for the health of this baby and definitely if she ever wanted another one, but in her specific situation smoking was better than the alternative.

I doubt that would ever happen in the US and I honestly wonder how they'd deal with that situation. Telling someone to smoke would be a lawsuit, but having a patient losing a baby due to stress/hypertension would likely mean a lawsuit too.

For me, personally, I like the fact that my doc encourages common sense and gives me leads on doing my own research. I like the feeling of being in control.

Sent from my Xperia Z, please don't mind typos!