Caught in the torque

by Possible Modernist

Suspended Reason recently wrote a post about the concept of torque policy, which we can summarize as recommending a course action that exceeds what is strictly necessary, in part because you assume that most people will fail to fully adhere to the recommendation.

There’s a bunch of great examples in that post, but the one that immediately came to mind for me was the question of drinking alcohol during pregnancy.

This is sort of a complicated one for all the reasons that pregnancy is complicated: it involves truly dramatic structural and hormonal changes to the body, hopes and fears about the future, and a real possibility of things going badly wrong. Unsurprisingly, there are multiple industries built up around stoking and satisfying the desires of expecting parents to prepare for, celebrate, and safeguard the future of their unborn child.

Although they don’t quite benefit in the same ways as other players, doctors are an instrumental part of this ecosystem, as they will provide the expert advice on what women should and should not do during pregnancy. For many women in the U.S., part of the advice they will get from their doctor will be to completely avoid alcohol while pregnant.

We know enough to know that heavy drinking during pregnancy can lead to profound impairments for unborn children, as in fetal alcohol syndrome, and for that reason, it seems important to make sure pregnant women know that they should avoid excessive alcohol consumption. But what is excessive? Well, that’s where things get complicated.

First off, it’s going to depend on the person (e.g., body weight, etc.). But more importantly, we just don’t have a very good scientific understanding of this. Overall, there seems to be very little evidence that mild alcohol consumption will have detrimental effects, but it’s also a case where running a randomized control trial is probably impossible. On the other hand, it is usually reasonable to assume that most things have some sort of dose response, where the more you drink the worse it will be. Unfortunately, we just don’t know where the safe” line is, if there is one.

All of the above is probably familiar to most people, but here’s the interesting question: where is the torque?

The obvious answer is that the doctor is torquing their patient: they know that if they say an occasional glass of wine is fine, then some women might drink more than that, which could be getting into dangerous territory. So they just tell everyone that they shouldn’t drink anything, in hopes that those who would cheat will end up sticking closer to zero than they otherwise would have.

But is that actually how doctors are thinking about this? Perhaps the real torque is on the insurance side of things. Perhaps there are liability issues, where doctors know that they could be held responsible for even things that are not strictly their fault, and so they are being torqued (across all diagnoses) into being extra cautious.

Alternatively, perhaps the torque is being conducted by medical advisory boards or scientific agencies putting out broad recommendations which they hope that doctors will follow. Perhaps they expect that if they tell doctors to explain all of the nuances to their patients, then some doctors will be excessively lenient in their recommendations, and so those writing the policy are attempting to torque the doctors.

Or is it possible some patients are in some sense torquing themselves? Perhaps some women fear that if they internalized the fact that there is little or no evidence of harmful effects from mild alcohol consumption during pregnancy, then they might get careless at some point, and so prefer to receive and believe the recommendation to remain teetotal?

To be honest, I don’t know enough about how the medical system works behind the scenes to know which of these might be relevant. Nevertheless, it is interesting to think that torque policy may in some cases be quite distributed, and hard to pin down to a single source.

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