What to do when best is impossible (Emily Oster)

[follow_the_word]

I know Emily Oster is controversial here. I don’t necessarily agree with all of her takes nor do I think (unfortunately) she’s necessarily great at assessing the state of the field on every topic she writes on, and I don’t always agree with how she presents the data she does share.

However - I find her framework for decision making and way of presenting it incredibly accessible and useful. I think she’s an engaging writer and she often adds nuance to a discussion.

I liked her latest newsletter, about (effectively) harm reduction. Many times, major medical bodies (or evidence based spaces) focus on “best” without necessarily a nuanced discussion of what tradeoffs you might make if best is not an option for you. Instead it’s best or (as she frames it) “outer darkness” for all sorts of parenting decisions — ABC sleep, forward facing early, child nutrition, etc etc.

It’s helpful for me to think about how best scientifically does not necessarily mean best for me and then assess how much additional risk I’m comfortable taking on. Thought this community might enjoy the read!

 

[grace4nan]

@follow_the_word I think this nuance is missing in nearly every aspect of parenting. I'm lucky that I'm an engineer and have completed risk based assessments on many many things professionally. I apply that risk framework to the rest of my life. (But with less math and documentation).

It's basically why I have no patience for Redditors on their high horses because they never co-slept, kept their kids rear-facing till they were 5 and have never done everything wrong ever. Some people can do the "best" and others make different choices. Saying don't do that is not helpful.

The world is filled with risk, and parents need to know how to assess risk, mitigate risks when practical, and know their personal risk threshold. We cannot eliminate all risks, and trying to live like you can is lying to yourself. And stressful.

 

[julia736]

@grace4nan This 1000%. I’ve taken “breaks” from a lot of parenting subs with all of these parents who apparently have perfect kids who eat perfect meals and face backwards until they’re 5 and have slept independently since 6 months with never a night of bedsharing. Life is messy and happens in the grey area. The absolute view on “shoulds” massively contributes to parent anxiety IMO and is detrimental to day to day mental health and satisfaction.

 

[junebug72]

@grace4nan Erasing this nuance also weirdly pushes people who choose the less beneficial behaviour to excuse it by pretending there’s no risk. Many bed-sharing/ free-birthing/ whatever advocates promote their worldview by saying it is perfectly safe, rather than acknowledging that, yes, there are increased risks, and we can be aware of that and still choose to do something a certain way.

You don’t hear anti-vaxxers say hey I know my kid is more likely to die of meningitis or pertussis but I still make this choice. Instead it’s nitpicking stories or data to support your worldview and pretending the others don’t exist, which is a bit batshit.

(Note I’m by no means trying to suggest that these examples are at all comparable in terms of risk/ benefit!)

 

[grace4nan]

@junebug72 Yes so true. I have a friend, also an engineer, who turned her child forward facing as soon as she could. Another friend has a baby 1 month older and couldn't believe she made such a reckless decision. But it was great to see my intelligent friends talk it out. Neither claimed to be right, both just said they were doing the best for their families with the cards they were dealt.

 

[quigonj]

@grace4nan It is ALL about risk tolerance, and a person is not automatically irresponsible for having a higher risk tolerance in certain areas

 

[jeraxel]

@quigonj “anybody driving slower than you is an idiot, and anyone going faster than you is a maniac” said George Carlin

 

[wemchud]

@follow_the_word If you give the general public even the slightest excuse to do the convenient-but-more-dangerous thing, then they will absolutely do it. So yes, there's a reason health officials leave out those details, they know that fools will use it, cause something bad to happen then point the finger that they were told WELL ACTUALLY THEY SAID THE SAFEST WAY TO COSLEEP IS....

 

[follow_the_word]

@wemchud Isn’t that analogous to abstinence only education? Abstinence is absolutely the only fool proof way to prevent teen pregnancies or STIs and teaching only abstinence is also a fairly clear way to fail at preventing teen pregnancies and STIs versus teaching safe sex practices (harm reduction).

 

[brianball]

@wemchud This kind of idea - stems from "risk compensation" theory and has been shown time and again to be flawed in studies of human behavior. I first became aware of this theory and how its influenced American policy for decades when I was pregnant alongside having a chronic health issue and, in working with my MFM and reading about the standard care with my relatives abroad in England, realized that American health officials adhere heavily to the risk compensation fallacy. Like "no Advil at all" instead of "no Advil after 20 weeks," or "no hot baths or hot tubs" instead of "hot baths for the first 6 weeks might pose a risk, as of yet unconfirmed, to neural tube development, but after that, the risk to the fetus goes away as the neural tubes close. However, be careful not to dehydrate," as my MFM said, and as the NHS in England says (though the NHS does its own mild risk compensation and says first 12 weeks). Risk compensation largely does the opposite - leads to less safe choices as people are left without guidance, and/or become cynical and stop trusting in expertise when they realize they've been mislead by officials.

https://slate.com/technology/2021/1...bunked-masks-rapid-tests-vaccines-safety.html

 

[cutin]

@brianball Yes, this! Plus it's massively patronising, the idea that people are a general mass of stupid, immoral people who are out for their own destruction.

I mean, yeah, people have varying levels of reading comprehension and messaging should not be too complex. But the destroying trust issue is a serious problem and I feel like that is just becoming more and more clear since covid and the whole polarisation effect, but people still want to write off those who mistrust authority as being fringe conspiracy lunatics instead of looking into what might have happened to inform that mistrust.

 

[princesswarrior30]

@cutin

it's massively patronising, the idea that people are a general mass of stupid, immoral people who are out for their own destruction.

Well said! ...although I'm definitely reminded of this scene from The Life of Brian, especially this part:-

Brian: "You're all individuals!"

Crowd:"Yes, we're all individuals!"

Gadfly: "I'm not."

Crowd: "Ssh!"

 

[iambridget]

@brianball I'd really hoped the pandemic had changed some minds about this. "People are too stupid for nuance in instructions" has an enormous body count thanks to covid.

 

[sdhanon]

@iambridget This is so true. I struggled most of all with the lack of the WHY and logic around instructions I was told to blindly follow. And then we ended up with infectious kids coming to school playgrounds for pick up because there was no option for the parents

 

[katrina2017]

@grace4nan My wife and I have this argument all the time. I'm in bioinformatics so disposed to believe (by way of professional necessity) that we can develop ways for our simple brains to comprehend complex systems and make practical decisions (generally by removing the human calculators as much as possible). My wife is in a complex pediatric specialty in which sure, she could train up every parent so they could understand the relative risks...it would just take a few hours, and perhaps with a few exceptions not lead the family to feel significantly more confident. I'm certainly (to my eventual detriment perhaps) not the sort, but most people defer to their doctor or find another doctor, and they do the same with public health messaging. People generally shop around for something or someone who satisfied their priors and either passes the bullshit test or simply contradicts the authority that doesn't, which frankly is where the CDC has shot themselves in the foot so many times. In direct medical care it's a balancing act---empowering people to make a series of contingent choices in complex medical scenarios when they're sleep-deprived and either ill themselves or terrified for a loved one isn't likely to yield better decisions. So it's a matter of sussing them out, not witholding but not simply throwing choices in front of them they don't have the tools to deal with. There should be more conversation with patients about medical decision making, and less aversion to getting close to the weeds about the decision making process It has to be the same with public health messaging, or at least back off on the invective and have a little understanding with things like co-sleeping, or persons who may possibly be pregnant whether they know it or not having a damn glass of wine...in person people are generally reasonable and will provide more context and tailor their messaging, but the brute force of the soundbites and press releases get magnified by very well meaning but anxious and overcaffeinated folks whose demands for utter adherence aren't what the actual experts are asking for or expecting. The way people receive public health messaging is somehow even worse than pre-internet, despite all the pertinent information being right there at our fingertips...most people skim headlines, and then tell their peers their hot takes based on that skimming.

 

[kingdomkings]

@katrina2017 That is an interesting perspective. Thanks for sharing.

 

[thespiritmolecule]

@grace4nan While I agree with your perspective, my guess is because we live in a litigious society in the west (in particular, the US).

 

[atl3128]

@wemchud What you are missing is that when things are 0 or 100, then those who can’t do 100 just go straight to 0. It’s kinda like “Don’t eat Wendy’s hamburgers, eat steamed fish and broccoli with very little salt”. Yeah, one is very healthy option and one is extremely unhealthy, but having seasoned, oven roasted chicken thighs with oven roasted potatoes and slaw is great middle ground. It will have more calories, thighs are not as healthy as chicken breast and Mayo is not the healthiest option, but it’s still WAY better than Wendy’s. So the same here - if you can’t do the best, what is something you can do that is still better than the easiest, most dangerous option.

 

[dmm]

@atl3128 Problem is in a litigious place (like the states) options 1-99 can get you sued out of house and home.

 

[kilroy59]

@dmm There are thousands of quack instagram accounts that are giving advice for baby eating, baby sleep, etc. How many of them have been sued out of house and home?