Economics Versus Medicine

There is a piece in the WSJ, a paper which now appears as some pop publications with all sorts of things other than the financial news, which was written by an economist bemoaning medicine. The article was written by a female economist. She bemoans all the advice that is given women as to how to care for themselves during pregnancy. Her main gripe appear to be that there is little if an evidence behind any of this advice.

Now she complains about coffee as follows:

A far bigger issue for me was coffee. I love coffee. The thought of giving it up during pregnancy struck fear into my heart. Of course, for the baby, I'd do anything. But I didn't want to do it for no reason.

The big concern with consuming caffeine during pregnancy is that it might lead to higher rates of miscarriage. Caffeine can cross the placenta, entering the fetus's bloodstream, and it isn't clear how the fetus processes it. In addition, researchers have speculated that caffeine can inhibit fetal development by limiting blood flow to the placenta.

Still, these effects have not been proven. In the end, randomized experiments are difficult or impossible, and women who drink coffee tend to be different from those who don't. One big issue is that older women tend to drink more coffee, and age and miscarriage are closely linked.

Now I know little about obstetrics, I did deliver a baby or two, but that was decades ago. It may be like riding a bike but I dare not try that. However, mothers are given tons of advice which may or may not be scientifically based. She further bemoans that:

I'm hardly alone. Pregnant women are clamoring for better information about everything from exercise to hair dye to bed rest and delivery. They don't want categorical limits based on fuzzy science and half-baked research. They want to assess risks for themselves and make their own best decisions. 

 Now let me deal with a few facts:

Physicians have a ton of data regarding smoking, drug use, excess alcohol, preexisting conditions, age related birth issues, genetic complications and the like. I have a few old obstetrics books on my shelves that relate those warning and even way back then there were clinical studies and true science backing up the claims. But a cup or two of coffee or a glass of wine may be  a bit too over-bearing, except that in today's legal mess of malpractice what is a physician to do.

On the other hand did an economist ever get sued for malpractice? Hardly! Did an economist ever do a double blind study? Never. They can even do a study in macroeconomics with their eyes fully open. Thus I see this bemoaning the failures of medicine as a complete admission of the real total failure of economics. There is no body of science akin to physiology, genetics, and the like in economics. No economist can do an experiment. They only play with numbers after the fact and when they try to predict, diagnose, prognosticate, the seem to end up in screaming matches where no one even comes close to the right answer.

So we have a female economist bemoaning the issue of whether two or four cups of coffee will do fetal damage. I do not know, I have read the literature. I can do some good guesses on clinically based results in several fields of cancer, but telling a person whether a glass or two of red wine at dinner is bad for the fetus may be difficult unless some study has been done, but I suspect that there are hundreds.

Perhaps Economists who live in glass castles should not throw stones.

Oh yes, I just checked my NEJM looking for caffeine and pregnancy and got a few dozen hits. The latest is worth a look. The NEJM article states:

Obesity, cigarette smoking, alcohol use, and moderate-to-heavy caffeine use may be associated with sporadic miscarriage, but relationships between these conditions and recurrent miscarriage have not been extensively studied and are uncertain. There is no good evidence that physical activity, including sexual activity and exercise, causes miscarriage.

References:

1. The ESHRE Capri Workshop Group. Nutrition and reproduction in women. Hum Reprod Update 2006;12:193-207
   
2. Mishra GD, Dobson AJ, Schofield MJ. Cigarette smoking, menstrual symptoms and miscarriage among young women. Aust N Z J Public Health 2000;24:413-420
   
3. Henriksen TB, Hjollund NH, Jensen TK, et al. Alcohol consumption at the time of conception and spontaneous abortion. Am J Epidemiol 2004;160:661-667
   
4. Weng X, Odouli R, Li DK. Maternal caffeine consumption during pregnancy and the risk of miscarriage: a prospective cohort study. Am J Obstet Gynecol 2008;198(3):279.e1-279.e8.

 Hope the facts help out here!