Title: Natural Causes
Author: Barbara Ehrenreich
Barbara Ehrenreich, who has a PhD in cellular immunology, provides an accessible guide to modern medicine in Natural Causes. She discusses the current trend towards wellness and a longer lifespan and the fear of death that underlies it. She begins by talking about routine tests in doctor’s offices and progresses to how much is still unknown about illness and aging.
I thought that the most fascinating part of the book was her explanation of macrophages, cells which are part of the immune system. When she was studying for her degree, she thought of macrophages as the hero of the immune system because they perform so many important functions, eating dead cells and helping to heal wounds. However, more recent research has uncovered that macrophages actually assist cancer cells in growing and spreading, eat lipids and block arteries, causing heart attacks, are one of the main culprits in attacking healthy cells in autoimmune disorders, cause inflammation, and might be one of the causes of Alzheimer’s disease. In other words, you can adhere to a healthy living program, eating whatever is the current fad, working out regularly, and still be done in by an aspect of your body that you can’t control.
Ehrenreich is critical of the traumatic aspects of routine tests that are not evidence-based and haven’t been proven to be largely effective in saving lives. She compares the shaman practices studied by anthropologists with the detached and ceremonial role of doctors in our modern society. They dress in white coats and perform acts that are mostly done only because they have been for generations and because, as she quotes one doctor as saying, the patients expect it. She says that there are many reasons not to completely throw out preventative testing. For example, if someone really needed to have a test done, then insurance companies might refuse coverage on the grounds that it is not medically necessary. But she’s advocating for people to make informed decisions and not just blindly follow a doctor’s advice.
She also attacks the classism at play in the interpretation of what is healthy and what is not. For instance, many people who smoke live long lives, and some people who get lung cancer never smoked a day in their lives. Not all fast food is unhealthy. Some things are just out of your personal control. We give a privileged stance to the wealthy. Certain fads are given widespread coverage, like mindfulness, which has had a large boom in books and apps, and subsequently profit for its practitioners, despite the fact that it’s not proven to do anything to improve mental well-being. We are meant to admire those who do risky things like attempt to climb Mount Everest, even though it has a high death rate, because only the wealthy can do something like that. But we don’t try to understand why lower-class people smoke or eat fast food. She talked to one woman about why she smoked, and she said that she worked long hours and smoking served as a kind of stimulant, keeping her awake and de-stressed when she was exhausted so she could deal with everything in her life. Ehrenreich is very sympathetic, and I think she has a point. No one would advocate smoking, but why heavily tax a thing impacting mostly lower classes, which brings a level of enjoyment?
The larger theme of the book is about coming towards an acceptance of death and aging. When we read about someone else’s death, particularly a very famous person, we try to look for causes behind it. Did they drink a lot? Smoke? Live an unhealthy lifestyle? We want to assign blame because we don’t want to believe that death could be random or unfair. However, it will happen to us all one day, no matter how much healthy food we eat or how much we exercise. Ehrenreich notes that she sometimes eats butter or drinks wine, knowing that it isn’t the healthiest choice, but that life wouldn’t be worth much without things she enjoys. She talks a bit about some very wealthy people who plan to live to advanced age, but she also asks us to consider what quality of life we’ll have if the only goal is to extend life. I picked up this book largely because it falls outside of my usual reading scope, and I’m glad I read it. Ehrenreich offers a sensible account of medicine and health that made me more aware of my own views about wellness.