Thursday, August 22, 2013

What to expect from an expecting economist

It is not every day that a new book about parenting comes out from an academic economist. This time around, however, the book was not about parenting but pre-parenting. Emily Oster, a University of Chicago Booth School economics professor, became obsessed with the rules being laid down for her when she became pregnant; so much so that she decided to research them and now write a book about what she found. The book is called Expecting Better and I have to say that I picked it up with relish in the hope that I could start this review with "well, I was expecting better" but instead, I have to say, upon reading it cover-to-cover in a single sitting, "I was expecting worse."

Here is what I was expecting: a fairly dry review of the medical basis behind lots of pregnancy advice with a high degree of qualification that would really only be of interest to people while they or their spouse was pregnant. In other words, I didn't think it would be interesting to me as I was more than done with pregnancy but I did hope it was something I could recommend to the pregnant.

Instead, what was delivered (pun intended) was quite a personal account. Here is the story of a woman who finds herself completely at sea and out of control in what is most likely the major transformational event of her life. She receives a raft of rules set down by convention and medical dictate that have the immediate effect of making her life worse and more stressful. And so to cope she does what surely many have done before her and asks, why? 

The problem most people face when they ask "why" is that they are not equipped to wade into the medical literature and sort something useful out. There is a raft of terminology, a myriad of journals (if you can get access to them) and then there is the methodology behind the studies. Oster believes that it was her training as an economist that gave her the skills to take on the challenge of answering the why question but, in fact, she was much more than that. Oster is a health economist and one who has already delved deep into the medical literature for her research. To do so again for this task was, in fact, quite natural. Indeed, as I'll come to in a bit, Oster has received huge amounts of criticism for her findings, many of which claimed she had no right to write this book as an economist. However, when you look at her research, that charge is completely unfair. Compared to some of us who make pronouncements on things outside of their economic expertise, Oster was close to her core speciality here.

But it was the style of this book that gives it power. It is a narrative of Oster's own pregnancy with her first child and takes us through those stages. But along the way she explains to the reader statistics, the importance of distributional assumptions, selection bias, correlation versus causation, and decision theory. While the subject matter is special, the explanations are first rate. A great example is the chapter on prenatal screening and testing. This involves the decision to undertake noninvasive and invasive tests for chromosome disorders in your baby. This is actually a situation where parents have some discretion over what to do. But Oster convincingly takes the reader through the real probabilistic calculations (including conditional probability) in a very accessible way. That entire chapter would surely be one of the great cases to give to MBA students. I only wish we had thought about half of the issues there when making our decisions 15 years ago on this issue.

Not all information was as hard to parse as prenatal screening and when it is easy, Oster is straightforward about it. Even so, she finds the underlying studies and presents them. There is hardly an issue from conception timing to choosing whether to induce that she does not touch on. To be sure, she skirts the entire subject of whether to prepare the baby's room prior to pregnancy and also whether her pre-birth house changes actually ended up making sense but, for the stuff where there is a medical literature, Oster is there. That said, she never touched on the issue of whether father's should deliver their own babies (as I ended up doing) but I suspect there just isn't a literature on that.

Inevitably, coverage of this book has been controversial. Not surprisingly, her publishers put out extracts, not on whether gardening is a good idea or even whether to take anti-nausea medication (although one wonder's what Oster's mother-in-law thought of the chapter title "Nausea and My Mother-in-law"!) but instead that it was OK to drink alcohol and have coffee in moderation. This flies in the face of the general blanket advice and also the cultural lore on pregnancy. And before Oster, millions of mothers have forgone much for the "good of the baby" and surely had built a mindset that it was all worth it. Here, Oster was saying that maybe it wasn't worth it and, it was hardly surprising, that this was seen as an affront; the sort of affront that can get you many one-star Amazon reviews from people who clearly had not read the book.

I can sympathise with that. I've been there. I mean, I suggested that parents should think about themselves when getting a baby to sleep. How dare I!

There is, however, a deeper issue here. I know many people who like to understand where blanket rules come from and to decide for themselves. This is hardly surprising as academic economists constantly are asking why and challenging one size fits all approaches. However, there are also people who prefer to be told what to do, especially when it comes to medical issues of which there are possibly consequences. Do you really want to have personal responsibility for issues when you can leave it in the hands of professionals? After all, when it comes down to it, in no place did Oster give advice that it was OK to decide what to do when the baby's health was at risk. Whenever that happened she unambiguously advised against breaking conventional norms. Instead, what she does is reduce the set of rules that you have to obey. For some people, being given discretion may not give them satisfaction.

This book is not for them. It is for, I guess, those on the more neurotic side of parenting who want to know what is going on. Oster serves them well. She takes her own angst and has generated a public good that may actually go along way towards making people's pregnancies easier, more understandable and less stressful. We could have used this book 15 years ago and my spouse would have had more sushi as a result. 

But I couldn't help but think what is coming. Oster is a parent now and if you think the advice is ambiguous prior to birth that is nothing compared to what it is post-birth. I can only imagine Oster is devouring those studies and will in a year or so produce the next volume in the series. For me, that involved a more rigorous application of economic theory than books on parenting had ever done. However, I look forward to the data on those issues being neatly synthesised. It will be doubly interesting because Oster's parents, both academic economists, did the same thing using Oster as a three year old subject; finding that baby babbling in a crib was actually coherent. Actually, make that triply interesting, as Oster's husband, economist Jessie Shapiro, will likely be a stronger part of that (he was kind of hands-off during pregnancy) and has already, as pointed out on page 1 of Expecting Better, delved into controversial parenting subjects in his own research. I definitely have high expectations for that work now.