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Them’s the Rules!

August 25, 2015

What do an amniocentesis and a public school have in common?  Funny you should ask…

Facebook is a mixed blessing.  If you dig through all the pictures of people’s kids, selfies in front of Cinderella’s castle, and what everyone ate for dinner, people put some really great stuff.  For instance, this article in The Atlantic from a couple of years ago: Thinking About Pregnancy Like an Economist, by Emily Oster. (

The story is that Ms. Oster and her husband decided, like many a couple throughout history, to have a baby.  Both people being economists, they made this decision like economists.  Here’s Ms. Oster:

Ultimately, microeconomics is the science of making decisions–a way to structure your thinking so you make good choices. Making good decisions–in business, and in life–requires two things: the right data, and the right way to weigh the pluses and minuses of a decision personally. The key is that even with the same data, this second part–this weighing of the pluses and minuses–may result in different decisions for different people. Individuals may value the same thing differently. Making this decision correctly requires thinking hard about the alternative, and that’s not going to be the same for everyone.

Ms. Oster naturally assumed that any decisions she had to make during the pregnancy could be handled in the manner outlined above.  She assumed wrong.

Anyone who has been pregnant knows the mountain of dos and do nots that shower pregnant women wherever they go.  Don’t drink. Don’t eat deli meat. Don’t drink caffeine. Do get your triple screen. Do eat organic.  Don’t run.  Do run if you’re a runner.  Don’t sleep on your back. Do make a birth plan.  Birth plans are for sissies.  You know how it goes.  Ms. Oster ran into all of these, but she ran into something else: Medical Protocol.  In other words,” There are rules, Ms. Oster, and here in pregnancy land we follow the rules.”

In reality, pregnancy medical care seemed to be one long list of rules. In fact, being pregnant was a lot like being a child again. There was always someone telling you what to do. It started right away. “You can have only two cups of coffee a day.” I wondered why–what were the minuses? What did the numbers say about how risky this was? This wasn’t discussed anywhere. Then we got to prenatal testing. “The guidelines say you should have an amniocentesis only if you are over thirty-five.” Why is that? Well, those are the rules. Surely that differs for different people? Nope, apparently not (at least according to my doctor). Pregnancy seemed to be treated as a one-size-fits-all affair. The way I was used to making decisions–thinking about my personal preferences, combined with the data–was barely used at all.

Well, Ms. Oster, wait until your child goes to public school kindergarten.  You are in for a whole world of hurt, my friend.  Take, for instance, the requirement that all children have an updated physical exam from a physician every year.  Sounds like a good idea, and probably a good idea from a parenting perspective.  But as a blanket rule, is it really necessary?  Does the school nurse read every one of these reports?  Is there any data to support greater safety or superior learning in kids who have a physical exam on file in the office? Then there’s the lab work.  Every child must have a documented lead level at some point in their lives before entering kindergarten.  Why?  Is every kid in town vulnerable to lead poisoning?  If I have a completely healthy and normal kid what is lead screening going to tell me?  If my kid lives in a house built in the last ten years, has never eaten paint, and to my knowledge has never eaten any toy made in China, why do I need to subject my kid to a needle?

Sorry, I was ranting there for a minute.  The point is that people who enter the health care system (or the public school system) are subjected to a lot of arbitrary rules imposed by well-meaning people who have no data, or who once had data but that data no longer applies, or who just think “it’s a good idea”.  For some patients following the rules works for them.  For patients like Ms. Oster who, what with that PhD in economics and all, needs more data, doctors had better be able to come up with some.

Now, if you’ll excuse me, I have to go follow some rules.


From → education, Healthcare

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