Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer

by Barbara Ehrenreich

From the celebrated author of Nickel and Dimed , Barbara Ehrenreich explores how we are killing ourselves to live longer, not better.

A razor-sharp polemic which offers an entirely new understanding of our bodies, ourselves, and our place in the universe, Natural Causes describes how we over-prepare and worry way too much about what is inevitable. One by one, Ehrenreich topples the shibboleths that guide our attempts to live a long, healthy life -- from the importance of preventive medical screenings to the concepts of wellness and mindfulness, from dietary fads to fitness culture.
But Natural Causes goes deeper -- into the fundamental unreliability of our bodies and even our "mind-bodies," to use the fashionable term. Starting with the mysterious and seldom-acknowledged tendency of our own immune cells to promote deadly cancers, Ehrenreich looks into the cellular basis of aging, and shows how little control we actually have over it. We tend to believe we have agency over our bodies, our minds, and even over the manner of our deaths. But the latest science shows that the microscopic subunits of our bodies make their own "decisions," and not always in our favor.

We may buy expensive anti-aging products or cosmetic surgery, get preventive screenings and eat more kale, or throw ourselves into meditation and spirituality. But all these things offer only the illusion of control. How to live well, even joyously, while accepting our mortality -- that is the vitally important philosophical challenge of this book.

Drawing on varied sources, from personal experience and sociological trends to pop culture and current scientific literature, Natural Causes examines the ways in which we obsess over death, our bodies, and our health. Both funny and caustic, Ehrenreich then tackles the seemingly unsolvable problem of how we might better prepare ourselves for the end -- while still reveling in the lives that remain to us.

Genres: Nonfiction, Health, Science, Medicine, Medical, Death, Audiobook

257 pages, Kindle Edition

First published April 10, 2018

About the author

Barbara Ehrenreich was an American journalist and the bestselling author of sixteen previous books, including the bestsellers Nickel and Dimed and Bait and Switch. A frequent contributor to Harpers and The Nation, she has also been a columnist at The New York Times and Time Magazine.

Reviews

[LeeLee Lulu · Rating 3 out of 5]

(heads-up: this book is coming out April 10th. I read it early in exchange for an honest review.)

If Natural Causes were an essay, it would open with a thesis statement like: "Health trends are faddish and often counterproductive to a long and pain-free life. Many 'healthy' things we do -- including things licensed medical doctors do -- are tradition-based and scientifically unfounded. We need to carefully figure out how to treat ourselves from an objective and rational standpoint."

However, this book isn't as clear as all of that. If anything, it reminds me a lot of listening to Rage Against the Machine as a teenager:
1) I was interested.
2) The arguments against society's current way of doing things were valid.
3) Rage was present, but
4) I wasn't quite sure what the author's concrete plan for change was.

This book has so many wonderful parts, but they don't quite hold together as a unit.

Among other things, the author talks about:
How doctors are almost like worshipped shamans, with their special outfits and training. (Really interesting).
How a lot of medical practices have no medical correlation with health, and sometimes hinder it. (Also really interesting.)
How the descent of religion and the rise of industrialization have made people think of the body as a machine that can be controlled, part by part. (Never thought of this, and I'm into it.)
How obsessing over your health doesn't necessarily make you live longer, with examples. (Kay.)
LSD and new-agey things like meditation are hipster and not necessarily factual. (Help I'm slipping away.)
Long tangent about how the lower classes smoke as an act of self-soothing. (She seems to condone smoking here?)
Discusses the moralism of people judging each other's choices -- even in death. She says that, on some level, most deaths are considered suicides. If a fat person dies of a heart attack, if a smoker dies of lung disease, etc. (I love ethics discussions.)
The medical profession's obsession with DNA has us forgetting about the cell. (?)
A LONG DIGRESSION ON MACROPHAGES. (WHAT IS HAPPENING OH GOD WHY IS THIS SO LONG)
A conversation about the MEANING OF THE SOUL. (UGGGH)

I feel like the final third of this book could straight-up not find its footing. This book was not titled "Your Doctors Are Wrong And Also Macrophages." I would not have picked up that book. I have no idea why so much of my life got gobbled up by this topic. It doesn't fit in with the rest of the book's tone/content. It's like there was a word count that had to be hit.

But anyway, if someone had given me a heads-up to skip macrophages and the "just let the poor people have cigarettes" digression, this book definitely would have a solid four stars. I really did enjoy most of it. It was factual, snarky, and interesting.

[Trevor · Rating 5 out of 5]

One of my favourite jokes involves a person saying that they want to die like their grandfather, peacefully and in his sleep, not screaming and terrified like the passengers in the car he was driving. I read a few years ago that doctors aren’t allowed to write that you died of natural causes on your death certificate any more, even if you are 120 years old. You always have to die of ‘something’. And since you will have died of cancer or dementia or heart failure that also means that if you hadn’t died of that you would be still alive. And that implies we will one day ‘cure’ death.

Poetry has its warnings about immortality, the epigraph of The Waste Land is from a story of a Sibyl that Apollo wanted to sleep with who asked to live for as many years as there were grains of dust in a pile – stupidly forgetting to ask to remain young for that time. As the hundreds of years past and she shrunk away to nearly nothing, her new wish is to be allowed to die.

I think immortality sounds more fun than it would turn out to be. The idea of there being no one of your ‘tribe’ still alive sounds horribly lonely. I’m not sure I would like lifelike the one men who marry women half their age have to endure – that something I once saw joked involved never being able to make any cultural references related to the world prior to 1990.

In a previous book, the author talks about her brush with cancer and how this introduced her to the not so pleasant world of positive psychology. The idea being that if you die of cancer you probably deserve it, because you just haven’t been positive enough. This is, of course, doubly cruel since finding out you have cancer is hardly the stimulus for knee slapping good times, but any feelings of hopelessness or anger or despair are seen as a kind of suicidal death wish. As she points out there, there is zero evidence for any relation for feeling negative and dying – and ultimately, we can smile or we can frown, in the end we’re all going to die anyway.

The author has stopped going through medical screening processes now too. I haven’t given up on this, myself, but I can see what her problem is with this. That not only are their many false positives and negatives in these tests, but also, as she says, the number of islands that there are around the UK varies according to how closely you look. The higher the resolution, the more you find, and this is also often true of screenings. If you look hard enough you are likely to find something to worry about.

I’m not about to follow her advice on this yet, but we in at different phases of life. If my doctor asks me to have a scan for skin cancers, well, I will. A stitch in time and all that stuff. But I haven’t been tested for prostate cancer, a simple blood test, and that is because I read a few articles in The Conversation from doctors that said you’re better off not knowing – and that seemed good enough for me.

I really loved the chapter called Rituals of Humiliation. This is more true for women than for men, I know, but all the same, I’ve lain naked on an examination table with a doctor’s gloved hand so far up my arse I’ve been sure he was trying to check my tonsils. Men don’t totally escape medical humiliation. And I remember the line of doctors examining my wife who was having a breech birth with our second daughter and my thinking, in any other context this would be a truly gross form of assault and she would be traumatised for life.

And because so many of our ailments now are ‘life style’ related, there is always also an implied ‘well, you’ve brought this on yourself’ undertone to modern medicine. ‘Oh god, do I have to tell you how many chocolate biscuits I’ve eaten since I last saw you, doc?’

One of the things the author does do, as you would know if you read her ‘Nickel and Dimed’, is go to the gym. When I started my PhD I got a gym membership. I was terrified I would spend 3 years sitting on my bum and become even less fit that I already was. After the first day I wasn’t able to go back to the gym for about a week – because I wasn’t able to walk. I was seriously unfit. But it is now 6 years later and I can even do chin ups. This is about as fit as I’ve ever, ever been. All the same, I’m not sure that on its own would have been enough to have encouraged me to stick at it. If anything, I do it more for my mental, than my physical health. I really feel much better mentally after going to the gym. I know that sounds like crap, but it is true. I spend an absurd amount of time inside my own head, and so getting to learn how to skip, or run on a treadmill, or lift 40 kg from my shoulders over my head 24 times is really something for someone who has never done anything like that before. As she says, there’s no guarantees with this stuff and lifting weights doesn’t stop you getting run over by a bus, but I don’t do it now to live forever.

To be actually and really fit I would need to go on a diet – but I just can’t bring myself to do that. My doctor said to me I should try the 5-2 diet – that is, fasting 2 days a week. To which I thought, ‘You’ve got to be bloody joking’.

There’s a lovely chapter on ‘mindfulness’ and how Silicon Valley has gotten onto this particular bandwagon. And she is quite funny about it, really. A lot of our problems are blamed on how much screen time we are getting now – lack of sleep, social anxiety from comparing ourselves to the lies are friends tell about themselves on facebook, blindness from the blue light our screens give off – the idea that the people that have made our lives a misery are going to fix it with a ‘stop now and breathe’ app on our smart phones amuses me no end. And the idea that Ruby Wax and Gwyneth Paltrow are the unofficial spokespersons for Mindfulness ought to be the kiss of death for it.

The chapter on ‘Cellular Treason’ – where our cells literally go out of their way to help cancer cells kill us – is interesting, but I get more or less lost when there are too many words like macrophages, lymphocytes or phagocytic. The take away message from all this is our bodies are made up of nasty little bastards that are sometimes determined to end our lives for no apparent reason other than sheer bloody-mindedness.

This book ends in a way I wasn’t quite expecting. That is, with LSD and a call for us to ‘get over ourselves’. I’ve been thinking about the last bit of this chapter since I finished the book. I’ve been wondering if we should try to use psychedelic drugs as a means to overcome anxiety. I’ve been wondering if this is part of the reason why ecstasy became quite so big a few years ago – I’m 55, I’ve never taken ecstasy and have no idea if it is still big or not. All I know about it is that it removes the users’ sense of self and makes them feel at one with the world and everyone around them. Like I said, I’ve never tried the drug, but I can certainly see the attraction.

Years and years ago I had an operation (more a procedure, really). They had to put me to sleep but before that they give me some sort of opioid, I assume it was to relax me, and it worked a treat. They wheeled me up to a waiting room outside the operating theatre and there was a picture on the wall of a waterfall running through a misty fern gully. I’ve never known that level of peace and stillness. It was the only time I have used drugs like that and it was magical, warm and an utter lack of self-awareness or anxiety. It makes wine seem pathetic. I’m glad it isn’t more generally available. Still, I could feel myself drifting away – not into sleep, but quite literally my ‘self’ becoming less important. And afterwards I felt strangely changed. I honestly felt like I had a clearer perspective on the world.

Like I said, this book ended in a way I wasn’t expecting. I really enjoyed it – in fact, I’ve enjoyed all of her books so far. Perhaps this isn’t quite as good as Bright Sided, but this is still well worth the read.

[Diane S ☔ · Rating 4 out of 5]

Informative and Illuminating. This author has a doctorate in cellular immunology, so one can expect quite a bit on the role of the different cells within our bodies. Some of this was quite dense but I believe I did understand most of what she was explaining. That our cells have different functions and can also turn on us. This section of the book, which was in the last half, was not my favorite. I loved her explanation and witticisms on the self help industry, and the ways we are mislead, or handled as they say, by information and biases without any scientific background or explanation. The barrage of current, healthy diet plans, the constantly changing shoulds and shouldn'ts. The illusion that if people follow this or that, a happy, healthy, long life will be the result. But....maybe not, is it possible we are not fully in control of our own fate? That we can do everything we are supposed to, but have no guarantee?

She takes on the medical industry and there consistent insistence on screenings and tests? How valid are all these tests and if one has them what do the findings mean? Tests, leading to more tests, leading to medicines that have side effects that are almost worse then the disease. I was diagnosed with MS over fifteen years ago, after five years of incorrect diagnoses and two unneeded surgeries. My neurologist immediately started me on an antibiotic spasm medication, an antibiotic depressant, because this diagnosis was sure to cause depression and Avonex. Avonex is a weekly, self delivered shot, and I decided to do it on Fridays, as I would have the weekend to recover. from the very beginning the side effects were horrible. I spent Friday nights and most Saturdays with a high fever, shivering and shaking. Just awful. Stuck with it for a few months and quit. Since then, except for treatments for excerbations, the only meds for this I take is my antispasmodic. Luckily for me, I feel I am better off.

Anyway there is much information presented in this book, some I agree with, some I want to look into further. It does, though give me the chance or choice to make an informed decision, and made me think of my future health decisions.

ARC from Netgalley.

[Roxane · Rating 3 out of 5]

Eh. Feels rushed and not well thought out. The overall subject is interesting but not the approach here.

[Miranda Reads · Rating 2 out of 5]

Once I realized I was old enough to die, I decided that I was also old enough not to incur any more suffering, annoyance, or boredom in the pursuit of a longer life.

So, this one goes into understanding what exactly is behind a "natural cause" death and just about everything between life and the great beyond.

And for the most part, this one was okay.

It had a lot of interesting stuff in it...but the book did feel a bit scattered, and I think that's why I couldn't connect to it in the way I wanted.

The author did quite a good job (well, relatively good) at pointing out flaws in the system.

For example, lot of the preventative care that she spoke about doesn't actually prevent that much but it's almost tradition at this point to continue to pay for these constant, yearly tests.

For most people, throughout most of the twentieth century, medical care necessarily involved an encounter with a social superior—a white male from a relatively privileged background.

In addition, she goes into how medial procedures can be invasive and demeaning, as well as how no matter your amount of preventative care - chances are that something will get you in the end.

And from there we took more digressions - such as LSD meds, smoking (but spoken of in a positive light), a really, really long discussion on macrophages, more about how modern medicine can be bad, a tangent about disgraced professionals (Dr Oz, Gwenyth Paltrow's Goop) and the list goes on.

So, while the concept of the book was great...the actual execution felt sloppy.

There was a lot of interesting facts and tangents but I really don't know what her over message was (F*ck medicine, maybe?) and what she hoped to accomplish with this book.

YouTube | Blog | Instagram | Twitter | Facebook | Snapchat @miranda_reads

[Michael Perkins · Rating 5 out of 5]

Jeff Bezos and the futile quest for eternal life

https://www.theguardian.com/commentis...

(click "I'll do it later" on the article to access at no charge)

=============

Just re-read this book, focusing on the science in it, specifically human biology. If you don't read those sections closely you will not understand the rest of the book, in fact the rest of the book may annoy you if you don't understand the scientific basis for it.

Not only is the human body not a product of "intelligent design," it is also not a product of evolutionary genius. As scientists have learned more about the cellular level of our bodies, the more disturbing it is. All of us, no matter how healthy, fit, and conscientious we are, carry the seeds of our own destruction. This includes what was once thought of as defenders of our health, macrophages, that often betray us by aiding and abetting cancer in creating new avenues for it to spread and expedite it's growth. These cells also generate inflammation that spur along the aging process. Call it the chaos aspect of biology, if you wish.

If you think about it carefully you have probably known robust, very healthy people, who had great habits, who still mysteriously were afflicted with, say, pancreatic cancer and did not live long. You would not be faulted for thinking: "this is the last person I know who would die this way."

But the reality is that there are many cellular actions in our bodies that we have no control over. The paradox is that in a quest to stave off aging we can make things worse by pushing our bodies too hard in high impact exercise, fostering inflammation and skeletal damage, that will actually accelerate aging and death.

===========

First, let's start with the fact that the author has a PhD in cellular immunology from Rockefeller University. So she knows what she is talking about.

And, in fact, it was the biology chapters and the discussion of microphages that were my greatest takeaways. This has been lost on many "reviewers" because they describe the science chapters as too "dense" and even recommend skipping them. Well, then you really haven't read this book. They'd rather blather about how a gluten-free or vegan diet will help y0u live to 100. But let's look at the science, shall we?

Here's a quick excerpt from an article on macrophages....

“There is persuasive clinical and experimental evidence that macrophages promote cancer initiation and malignant progression. During tumor initiation, they create an inflammatory environment that is mutagenic and promotes growth. As tumors progress to malignancy, macrophages stimulate angiogenesis, enhance tumor cell migration and invasion, and suppress antitumor immunity. At metastatic sites, macrophages prepare the target tissue for arrival of tumor cells, and then a different subpopulation of macrophages promotes tumor cell extravasation, survival, and subsequent growth.”

This means these little buggers, that once seemed elements of genius in our evolved bodies, going around vacuuming cellular garbage, have a sinister side. As our cells age and stop renewing themselves, the macrophages rush in to vacuum up the debris, but also generate inflammation that causes pain. And if that were not enough, macrophages also help create gateways for cancer and aid and abet the replication of cancer cells.

In his excellent book, The Emperor of All Maladies, cancer specialist Siddhartha Mukherjee writes...

“Cancer, we have discovered, is stitched into our genome. Oncogenes [cancer causing cells] arise from mutations in essential genes that regulate the growth of cells. Mutations accumulate in these genes when DNA is damaged by carcinogens, but also by seemingly random errors in copying genes when cells divide. The former might be preventable, but the latter is endogenous [originating from within]. Cancer is a flaw in our growth, but this flaw is deeply entrenched in ourselves. We can rid ourselves of cancer, then, only as much as we can rid ourselves of the processes in our physiology that depend on growth — aging, regeneration, healing, reproduction.”

The uptake? We are not as much in control as we think. Contrary to what some reviewers say, this is not a message that we should not have a good diet and give up on regular exercise and take up smoking. Rather, when some people contract a disease at a young age and die (as happened with a friend of mine who just died of pancreatic cancer) it's not necessarily because he did something wrong. It falls in the realm of why our own bodies attack us, sometimes resulting in death.

-----------

new study....

https://www.theguardian.com/science/2...

(click "I'll do it later" on the article to access at no charge)

[Ivonne Rovira · Rating 2 out of 5]

Author Barbara Ehrenreich has produced some fabulous, must-read books: Nickel and Dimed: On (Not) Getting by in America and Bright-Sided: How the Relentless Promotion of Positive Thinking Has Undermined America. Unfortunately, this isn’t one of them.

Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer begins with Ehrenreich (now 76) explaining why she doesn’t get mammograms or Pap smears or annual exams: “I gradually came to realize that I was old enough to die…. Once I realized that I was old enough to die, I decided that I was also old enough not to incur any more suffering, annoyance, or boredom in the pursuit of a longer life.”

I think that refusing mammograms stands as an odd decision for a woman who is in remission for breast cancer; however, that’s not what made me find this book nearly unreadable. Despite the title, Natural Causes isn’t really a book about how the wealthy pursue life-extending treatments despite cost or lack of scientific evidence. That would actually be a pretty good book.

Instead, Natural Causes is, for the most part, a collection of essays on unrelated scientific matters: a diatribe against prostate-specific antigen screenings and annual pelvic exams (which is how my renewed issue with a mesh sling was discovered), a criticism of traditional medicine allying itself with “alternative” medicine as a marketing scheme, a takedown of the current “mindfulness” craze, the perfidy of macrophages. These essays aren’t really related to one other or to the introduction and first chapter in which Ehrenreich explains her refusal of routine preventative care, or to the chapter, “Successful Aging,” which decries the movement that blames the elderly if they don’t lead blameless lives and then don’t live to be 100, or the chapter, “Death in Social Context,” which chronicles the rise of victim-blaming when someone dies in middle age (as if that could ward off death in one’s own case). If she had built on these chapters (although “Successful Aging” and “Death in Social Context” are a bit redundant), the author would have had at least a decent book. Ehrenreich promised an exposé of the top 20 percent’s pursuit of long life and eternal youth, but instead she delivered a mish-mash of pretty boring science facts.

In the interest of full disclosure, I learned that I had breast cancer from a routine 3-D mammogram, and I received this book from NetGalley and Twelve Books in exchange for an honest review.

[Krista · Rating 3 out of 5]

We can, or think we can, understand the causes of disease in cellular and chemical terms, so we should be able to avoid it by following the rules laid down by medical science: avoiding tobacco, exercising, undergoing routine medical screening, and eating only foods currently considered healthy. Anyone who fails to do so is inviting an early death. Or to put it another way, every death can now be understood as suicide.

I received an Advanced Reading Copy of Barbara Ehrenreich's Natural Causes, and based on its subtitle (An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer), I thought it was going to center on the moral ambiguity of end-of-life care – keeping people alive at all costs, without regard to the quality of that life – but that's not really what this is (although that is covered, too). Primarily, it's about the way that we in the West are living at this specific point in history – giving our bodies over to a medical profession that isn't as altruistic or science-based as we assume, mistakenly believing that a “self” is a discrete and important unit whose death is final and tragic, frittering away our lives in forestalling the death that is as inevitable and natural as life itself – and while Ehrenreich is persuasive in these points, backing up every assertion with quotes and research, she ends this book in a place to which I don't think everyone will follow; I'm still mulling over whether I (perhaps an ideal reader for this material) am ultimately persuaded to follow her there, but I certainly enjoyed the journey. And the usual caveat: I do understand that I shouldn't quote from an ARC, that these passages may not appear in this exact way in the final edit, but especially with this material, I wanted to let the author make her argument in her own words (I hope that the irony is apparent in the opening quote I used; I appreciate that's the additional danger of excerpting out of context.)

Barbara Ehrenreich is a feminist and an activist, a big-picture journalist who dissects trends through the lens of their historical moment, and I don't believe that most of us think this way: we accept the ways things are around us as the inevitable result of “progress” towards some idealised present, and especially as that relates to health and science. We look at improvements in hygiene, nutrition, vaccines and antibiotics, nod approvingly at increasing life expectancy statistics, and assume that through science and medicine, these stats will continue to rise: can't Millenials expect to live comfortably to a hundred or more? Aren't tech billionaires working on the keys to immortality? But Ehrenreich says that there's nothing inevitable – let alone ideal – about where we are today medically, dismissing even the annual physical as little more than a ritual equivalent to “primitive” shamanism, complete with costumes, strict roles, and deference to occult knowledge. As a feminist, she decries the twentieth century's medicalisation of childbirth as paternalistic and demeaning for women, and more or less makes the point that today's insistence on annual mammograms and pap smears will someday be seen in the same light – as pointless at best, as proof of an ego- and profit-driven industry at worst. (As a breast cancer “survivor” [she hates that word], Ehrenreich has little good to say about the whole “cancer industry”, as can be seen in her award-winning article, Welcome to Cancerland .) As for herself, Ehrenreich has reached an age where she is no longer willing to participate in these rituals.

Having dismissed the state of modern medicine, Ehrenreich examines the rise of the personal pursuit of fitness as a marker of status (rich people can afford spas and gym membership, poor people eat poor food and are more likely to be prescribed the opiates that are killing them) and then proceeds to skewer the complementary wellness industry, deriding in particular the celebrity gurus. Ehrenreich mocks “the scientifically discredited Dr. Oz”, charges that Gwenyth Paltrow and her website Goop sells “self-absorption as the ultimate luxury product”; that Paltrow's wellness techniques “are not exactly evidence-based”, and even states that Jamie Oliver's efforts to modify school lunches without “bothering to study local eating habits before challenging them” was “a mortifying failure” in both the UK and the US. The latest trend, as Ehrenreich writes, is the holistic approach to the “mindbody”, and while plenty of self-help authors and motivational speakers are getting rich off the concept, the idea is not only illogical (if a person can control both her body and her mind from the outside to bring them into harmony, just what is doing that controlling?), but contrary to science:

Rejecting the traditional – and continuing – themes of harmony and wholeness, (Elie Metchnikoff) posited a biology of conflict within the body and carried on by the body's own cells as they compete for space and food and oxygen. We may influence the outcome of these conflicts – through our personal habits and perhaps eventually through medical technologies that will persuade immune cells to act more in more responsible ways – but we cannot control it. And we certainly cannot forestall its inevitable outcome, which is death.

Before she became a journalist, Ehrenreich earned a PhD in Immunology, so when she starts writing about body systems and cells, and especially when she writes about microphages, I necessarily defer to her expertise. According to the research, these microphages seem to have agency – they roam the body, “deciding” what work to do in order to support the immune system – and while they have a vital role in combatting disease, they also appear to trigger and encourage cancers and other inflammatory diseases (everything from autoimmune disorders to heart disease and Alzheimer's are apparently now known to be inflammatory diseases, promoted by our own microphages). So while we might be trying mightily to postpone our own deaths from the outside through diet, exercise, and medical interventions, at the cellular level, our bodies are independently determining our end dates:

Just as programmed cell death, apoptosis, cleanly eliminated damaged cells from the body, so do the diseases of aging clear up the clutter of biologically useless older people – only not quite so cleanly. And this perspective may be particularly attractive at a time, like now, when the dominant discourse on aging focuses on the deleterious economic effects of largely aging populations. If we didn't have inflammatory diseases to get the job done, we might have to turn to euthanasia.

To this point, I understood the philosophy of what Ehrenreich was writing about; the basic futility of denying ourselves the things we like in order to delay the inevitable. But the final thrust of the book takes a weird turn as Ehrenreich, always a big picture thinker, explains the historical markers that led to where we are now, and why it's so wrong. She writes that in the beginning we humans recognised the animism of everything around us, but that an “austere, reformed version of monotheism set the stage for the rise of modern reductionist science”. And when our supposedly increasingly rational minds then killed off our only God as well, we were preparing for the rise of the “self” as the most important unit of life (the concept of “the self” was only “invented” relatively recently by Descartes, et al), which made us begin to think of our individual deaths (for the first time?) as tragedies to be fended off. Here Ehrenreich quotes the writings of Jackson Lears:

The reductionist science that condemns the natural world to death is not “science” per se but a singular, historically contingent version of it – a version that depends on the notion that nature is a passive mechanism, the operations of which are observable, predictable, and subject to the law-like rules that govern inert matter.

Because microphages and other cells appear to make decisions (and as Ehrenreich adds, so too do the subatomic particles of quantum physics), she concludes that we are wrong to dismiss the natural world as merely “inert matter”. She shares the recent studies of terminal patients who have been given psychotropic drugs, and after “tripping” and recognising their place in the true animate universe, they were no longer afraid to die. I have read Ehrenreich's Living With a Wild God, and in it she describes how as an atheist and a rational-minded scientist, she was led to believe that nothing survives death – she certainly doesn't believe in a soul – but she has had a series of visions in which, out of nowhere, was revealed to her the pulse of life behind the curtain of reality (like “a burning bush” in her words), and the following (which I don't think would make complete sense to anyone who hasn't read Living With a Wild God) seems to be Ehrenreich's main thesis:

It is one thing to die into a dead world and, metaphorically speaking, leave one's bones to bleach on a desert lit only by a dying star. It is another thing to die into the actual world, which seethes with life, with agency other than our own, and at the very least, with endless possibility. For those of us, which is probably most of us, who – with or without drugs or religion – have caught glimpses of this animate universe, death is not a terrifying leap into the abyss, but more like an embrace of ongoing life.

And I don't know if, coming at the very end of this book as it does, this thesis can said to have been supported by what precedes it. It would seem that Ehrenreich's main points are that modern medicine can ultimately do very little to prevent our body's own efforts to kill us; which is a natural process anyway, and will return the stuff of our bodies to the living cosmos. I wonder if the takeaway most readers will get is that you should smoke and drink, eat that burger, skip the annual physical, because you're going to die anyway, and it doesn't matter because death isn't the end. And looking at those two proposed summaries, I don't know if there's truly a difference between them. As I began with, I enjoyed the journey of this read, but am left ambivalent in the end.

[Rebecca · Rating 3 out of 5]

(2.5) A decade ago, Barbara Ehrenreich discovered a startling paradox through a Scientific American article: the immune system assists the growth and spread of tumors, including in breast cancer, which she had in 2000. It was an epiphany for her, confirming that no matter how hard we try with diet, exercise and early diagnosis, there’s only so much we can do to preserve our health; “not everything is potentially within our control, not even our own bodies and minds.” I love Ehrenreich’s Smile or Die (alternate title: Bright-Sided), which is what I call an anti-self-help book refuting the supposed health benefits of positive thinking. In that book I felt like her skeptical approach was fully warranted, and I could sympathize with her frustration – nay, outrage – when people tried to suggest she’d attracted her cancer and limited her chances of survival through her pessimism.

However, Natural Causes is so relentlessly negative and so selective in the evidence it provides that, even though it’s sure to be considered for next year’s Wellcome Book Prize longlist, I would be unlikely to recommend it. In the first chapter, “Midlife Revolt,” which has been excerpted at Literary Hub and is worth reading, Ehrenreich writes of her decision to give up routine medical screening after a false positive mammogram caused undue stress. She decided once she passed 70 she was old enough to die without accepting a “medicalized life.” Moreover, she believes there’s an epidemic of “overdiagnosis,” especially in the USA, where there can be a profit motive behind testing. (This is certainly not the case in the UK, where the NHS doesn’t pester me about getting cervical smear tests to line any pockets; no, it’s about saving taxpayers money by catching cancer early and thus minimizing treatment costs.)

Ehrenreich goes on to argue that many medical procedures are simply rituals to establish patient trust, that cancer screening is invasive and ineffective, that there is little evidence that meditation does any good, and that fitness has become a collective obsession that probably doesn’t help us live any longer. It’s uncomfortable to hear her dismiss early detection techniques as worthless; no one whose doctor found cancer in the early stages would agree. The author also seems unwilling to confront her own personal prejudices (e.g. against yoga).

Although she uses plenty of statistics to back up her points, these usually come from newspapers and websites rather than peer-reviewed journals; only in two chapters about how macrophages ‘betray’ the body by abetting cancer does she consult the scientific literature, in keeping with her PhD in cellular immunology. Her most bizarre example of how our bodies aren’t evolutionarily fit for purpose is copious menstruation. Overall, the book is a strange mixture of hard science, social science, and, in later chapters, philosophy, as Ehrenreich asks about the nature of the self and the soul and what survives of us after death. As usual, her work is very readable, but this doesn’t match up to many other mind/body books I’ve read.

Favorite lines:

“The only cure for bad science is more science, which has to include both statistical analysis and some recognition that the patient is not ‘just a statistic,’ but a conscious, intelligent agent, just as the doctor is.”

“The objection raised over and over to any proposed expansion of health insurance was, in so many words: Why should I contribute to the care of those degenerates who choose to smoke and eat cheeseburgers? … we persist in subjecting anyone who dies at a seemingly untimely age to a kind of bio-moral autopsy: Did she smoke? Drink excessively? Eat too much fat and not enough fiber? Can she, in other words, be blamed for her own death?”

Originally published on my blog, Bookish Beck.

[Jeanette · Rating 3 out of 5]

I pondered nearly an entire day deciding if I was going to give this book a 2 star or a 3 star. 2.5 stars rounded up for the core of the accuracy to her overall "outlook" upon aging and death in the USA. And also that we are highly "over-doctored". Most of the evidence is anecdotal in this book, but regardless- a great deal of it IS true. Especially in the nuance of how aging (both women AND men too) humans who are over 66 or maybe 70 years of age are encouraged for "optimal" health care treatments.

Some of the cell information here will be over most peoples' heads and regardless of the rebel cell happening often or not- keeping diet for a better outcome immune system is probably a good 1st step. But once again, repeated testing and testing doesn't fit for certain times in life or people in those times. Not just my opinion, either. And most of the time when an issue is "found" that doesn't mean it will be interpreted to its sources or progression correctly either.

Her nuance to the role the patient plays IS 5 star. Her advise given to others, it's closer to a 2.5 star. We all have different bodies. The clue is, IMHO, that you are helped mightily to know your own and your own changes and reactions within what doctoring path should be chosen. She does get the nuance absolutely right of that authority /down directive that reigns in the health care systems for the aging I would guess at least 70% of all those who doctor for a specific disease, chronic condition or ailment of any kind- are now following all kinds of treatments and testings to the point of a lot of lemmings jumping off of cliffs. Without thought much at all, and just accepting of the fact that the doctor knows better. You may know better. You and your body have been buddies or not for a long time.

Her writing skills are just scattered essays that all rather seem disjointed to each other. But that's the topic too. Nothing is more scattered that 3 to 5 specialists and 1 general GP doctor- all giving you their own countdowns to "and then" treatments. And testing. And testing.

I almost wanted to give her 4 stars just for the osteopenia and other norms that occur when you age by the very nature of the human body. How so many medicines given for these many states do more harm than the condition they are made to treat ever will. That's 5 star truth. I know because one of those occurred in all its worst outcomes for me. But regardless of personal track records, she is spot on upon aging and attitude in general. Because we are all going to die. And some or most of us do not have much fear of that happening as much as for some of the routes getting there.

But every single decision should be one you make yourself. I've made many omissions now that are almost exactly similar to Barbara's here. For very good reasons. All. Terrible false positive testings and also because my blood work has never been "normal" my entire life. And because I nearly died twice before I was 30 for entirely different reasons (I had Last Rites both times)- I also know how sick you can get from medicine too. And very quickly. Also I feel like Barbara that I would much rather leave the timing to a higher Power and then do the best I can fixing what I can, but not trying to portend future illnesses either, as if they were a given.

Sorry for the length. But I think if you are a doctor person, and I have known at least a dozen in my life time- the kind who seek an answer and testing for all conditions and hurts as if that will be the best outcome for longevity? Especially if it is for varying complaints or conditions which MAY be ones of familial record or whatever. I have observed if you are doctor prone, that you WILL end up with multiple, multiple RX habits and musts by the time of your 50's decade. That's just how it runs now. Something wrong with a ache or pain or "off" number- and it has a pill to take or injection to remedy. And that does NOT equate with a longer longevity. It just doesn't.

Having at least 50 friends over 75 right now and having said good-bye to many others in the last 5 years, including my life long and very best friend who can never be replaced- I read this book. Not for me, because I've made my decisions. But for others who are presently doctoring themselves into a lifestyle that is obnoxious to their own core personalities and also like prisons for their own good will and laughter options in their lives. One man friend in particular who has had something wrong with him since his 20's and now they are putting him through weekly and bi-monthly head to toes (about 20 hours of ridiculous scanning and appointments per 14 days- I figured it out)just to remedy something which may be serious, but which is not FELT by him at all. He feels fine and can't even get out to fish or boat with us. That's ridiculous. And it's becoming common as dirt.

Health care itself- the entire definition of it has changed in the USA. The older definitions were far more accurate.

She has a strong point, but I feel that you don't get much out of this book except 90% of her own opinion. But that too, is NO little thing. Your opinion counts more than your doctors on many of the paths that are being trodden presently.

But you would never know that by the directives and "evidence" given within many health care services modus of operations right now- once you get on the assembly line for some of these- it's hard to get off.

One time last year at a party (all women non-bunco) we tried to plot all the friends who had passed and from what issues and how "healthy" their doctor and lifestyle habits were. That was far more a "fun" game than it sounds.

My Mother won the doctor or none doctor game. She lived to 85. She was 5 foot 1" and weighed way over 200 lbs her entire adult life. She had two major diseases after 40 and couldn't walk after about 63. One of those diseases lasted for 45 years and was used as a U.of Chicago case in documentation for her disease (acromegaly caused by a tumor on the pituitary). After being given the most terrible outcomes prognosis, including blindness, amidst other dire projections- and yet after about 6 months of constant measuring and in hospital (she was in for periods of a week doing bone measuring at least 4 times) and other evaluating testings- she just left. And did not doctor at all for the next 30 plus years of her life. And she did have discomfort at times, especially in her legs. She outlived every single one of her at least dozen skinny Irish girlfriends.
She was a supremely HAPPY person, and had laughter and social event surrounding her in endless proportions. She cooked for neighbors and all at least 5 times a week, standing with a walker. So I think the body is more than just the physical component. And that the present health care system does so much prevention now that it is actually a detriment to the whole. And maybe even for their time too- which could be given to those who label sick or are sick.

So this is anecdotal as well as this book is. Because I don't think it is the longest "here" that wins but the quality of the time too. And there are numerous young people now who act old and feel old because of what they have been told and what medications they take too. When what they really need is to grab some energy in different directions from what they have set in their minds as "important" to their health.

[Colleen · Rating 1 out of 5]

1 Star

**My #1 worst read of 2018**


ARC provided by Twelve Books via Netgalley in exchange for an honest review. And honest it shall be.


My expectations for this book were of an insightful, well-researched look at how society handles aging and death. Ehrenreich is a well-known author, successful, and educated. But Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer is one of the biased books I have ever read. It’s a hostile rant lacking in facts throughout which the author blatantly ignores any information that does not fit her own opinion. And her opinion is (if you want the short version): the entire medical field is a harmful hoax run by greed and sadism; and you are going to die anyway, so do what you want and then die, Dorothy, die.

Even though there were some things that I agreed with (such as the corporate greed of the pharmaceutical industry or how some fad diets can do more harm than good), the author's tone was off-putting. It seemed to be one long, extremely bitter rant dressed up as fact. As eager as Ehrenreich was to allegedly debunk the entire medical profession, her own "facts" were often lacking in substantial information. That was particularly dangerous considering that Ehrenreich promotes completely abstaining from all medical treatments.

It kind of makes it worse that she is highly educated yet put out something so prejudiced. She apparently has a doctorate in cellular immunology. Her chapter on microphages was about the only one that she managed to not sound like a raving lunatic. But she keeps mentioning the caveat that she respects science which in her opinion is completely separate from that “hoax” called medicine. Scientists are wonderful and smart but the minute you apply any of that to medicine it somehow become hooey according to her. Worse that than, she ironically is a cancer survivor telling people not to get any screenings or preventative care.

In terms of the setup of the book, most of the chapters ended abruptly. There was no cohesion to the writing. This really did seem like the rant of a bitter, unstable person. Her animosity seems into everything. Even the chapters had names like "Rituals of Humiliation" and "The Veneer of Science" as examples of the author’s hostility. She overuses quotation marks to show sarcasm and skepticism and on very commonplace terms. For example, she would talk about the “doctor” pretending to “treat” a patient.

There is a major lack of credible sources. References are often vague such as “one source said” which was a huge red flag. So I checked her references at the end of the book. I quickly realized that the few cases where she had even a semi-legitimate source she crowed it and spelled out everything short of the person’s social security number. But the rest were left vague. And sure enough, every time I checked those sources would turn out to be… shall we say, less credible.

She uses outliers as if they represent the whole segment. I’m sorry that she felt harassed at by a single gynecologist in the 60’s, but that does not mean the entire field is harmful and/or unnecessary as the author claims. This is another example of making broad claims based on her own anecdotal “evidence.” In fact, gynecology is one of the medical fields where the U.S. has more female doctors than male doctors which really puts a damper on her theory about them all being rapists and sexual sadists. Not that there aren’t female perpetrators in the world, but there certainly is no evidence that men (or women) become gynecologists just to sexually abuse other people. Or that such occurrences are anywhere near as common as she states. Has there ever been a creepy gynecologist? Of course. But that does not mean that the entire field is some conspiracy of sexual sadism.

Overall, Natural Causes is a prejudiced rant where the author completely picks and chooses information and manipulates facts as they suit her. Anything that goes against her personal opinion is automatically a manipulative conspiracy by pharmaceutical companies and their sadistic partners (aka the entire medical field). This book is one long, paranoid rant lacking in facts and lucidity. I might agree with some of her broad assumptions, but she is so extreme that it is dangerous. She tells people not to get any preventative treatments (this includes everything from cancer screenings to basic healthy eating and exercise). She blathers on about if positive thinking does have any effect on your body then it will only be to make your cancer worse. There was some falderal about cells being sentient and intentionally causing cancer.

She compares doctors to shamans and clowns and claims that the masks doctors wear are part of the “ritual” and are meant to intimidate people and encourage worship and fear. Never mind that there are clear scientific reasons that medical professionals wear surgical masks. But no, Ehrenreich told you they are only for ritualistic purposes and if you don’t believe her then you must be part of the mindless masses.

She accuses all doctors of violating person space and compares many medical procedures to sexual assault.

She uses far outdated medical practices as excuses of why modern medicine is terrible. Well, Crazy Lady, the same can be said of science: if you judged modern science by the many outdated, incorrect theories then you would conclude that science is full of hokum.

She says you are better off seeking alternative choices although she immediately follows that up with more of her “debunking” to invalidate all of those as well. She does admit to exercising but emphasizes over and over that she only does because she likes to exercise but never, EVER for health reasons.

She says that birthing practices are “rituals of domination” meant to demean and defeat women.

It’s ironic that she complains about the few voices of “reason” (aka people who conform to her opinions) being discredited. But she really ties the noose herself when she does exactly that through her own rabid tirades. She does not need any conspiracies to discredit her. She is already one rant away from wearing a tinfoil hat. (But perhaps she has eschewed tinfoil hats as yet another example of alternative trends.) Ehrenreich’s own embitterment poisons every word of this book. I picture her pounding on her keyboard and clenching her teeth as she accuses all modern medicine of being pseudoscience – while using her own pseudoscience as evidence.

Now, it may seem that this review is an overreaction. So here are some quotes to demonstrate. At first, I was not going to include quotes in my review, because I thought they seem out of context. But by half way through the book, it was clear that any snippet from this book can unmistakably demonstrate the author’s distorted propaganda and disintegrating state of mind.

About cells:

“It turns out that many cells within the body are capable of what biologists have come to call ‘cellular decision making.’ Certain cells can ‘decide’ where to go and what to do next without any instructions from a central authority, almost as if they possessed ‘free will.’”

“Things I had been taught to believe are inert, passive or merely insignificant—like individual cells—are in fact capable of making choices, including very bad ones.”

About doctors:

“Inevitably, a parallel was drawn between the healing rituals of supposedly primitive peoples and the procedures of modern Western medicine. The latter also take place in specifically designated spaced and are usually performed by costumed personnel, wearing white coast and sometimes masks, who also manipulate objects generally unavailable to the public at large.”

“Commenting on the occasional deployment of clowns to cheer up pediatric hospital patients, one canny observer noted the parallels between these newcomers to the medical scene, ‘primitive’ shamans, and the usual physicians, right down to the ‘unusual costumes,’ and even masks, worn by all of them. The patient undresses, the ‘healer’ (or clown or shaman) utters incantations and performs carious actions on the patient’s body. Then, in the medical case, comes the ‘confession,’ in which the patient is grilled as to his or her personal transgressions.”

“They are no more scientifically justified than the actions of a ‘primitive’ healer. They do not serve any physiological purpose, only what she calls ‘ritual purposes.’ The enema and shaving underscore the notion that the woman is an unclean and even unwelcome presence in the childbirth process. Anesthesia and the lithotomy position send ‘the message that her body is a machine,’ or as Davis-Floyd quotes philosopher Carolyn Merchant, “a system of dead, inert particles,’ in which the patient has no role to play. These are, in other words, rituals of domination, through which a woman at the very peak of biological power and fecundity is made to feel powerless, demeaned, and dirty.”

“In one sense, childbirth rituals ‘worked.’ The women giving birth were often traumatized, reporting to Davis-Floyd that they ‘felt defeated’ or ‘thrown into depression’: ‘You know, treating you like you’re not very bright, like you don’t know what’s going on with your own body.’ Yet, having submitted to so much discomfort and disrespect, they were expected to feel grateful to the doctor for a healthy baby. It was a perfect recipe for inducing women’s compliance with their accepted social role: rituals of humiliation followed by the fabulous ‘gift’ of a child.”

On doctor examinations:

“The interaction requires the patient to exhibit submissive behavior—to undress, for example, and be open to penetration of his or her bodily cavities. These are the same sorts of procedures that are normally undertaken by the criminal justice system, with its compulsive strip searches, and they are not intended to bolster the recipient’s self-esteem. Whether consciously or not, the physician and patient are enacting a ritual of domination and submission, much like the kowtowing required in the presence of a Chinese emperor.”

If you read those quotes and still think this sounds like a good book… well, there’s nothing I can do for you.


*Quotes are taken from the ARC and may not reflect the final published version.

RATING FACTORS:
Ease of Reading: 1 Star
Writing Style: 1 Star
Originality: 1 Star
Attention to Details: 1 Star
Plot Structure and Development: 1 Star
Objectivity: 1 Star

[Michelle · Rating 4 out of 5]

Barbara Ehrenreich, a renowned investigative journalist, political and social critic, author of 23 books has written Natural Causes: An Epidemic of Wellness, the Certainty of Dying and Killing Ourselves To Live Longer. Ehrenreich is extremely critical of the health, fitness and wellness craze that has filtered into nearly every aspect of life. Independent examination and questioning medical experts and advice was encouraged, along with the social and cultural forces that influence individual and public awareness.

With so many variables in pathological conditions from acne to arthritis that are linked to inflammation, the “bad cholesterol” that triggers inflammation that causes heart attacks and strokes—many doctors believe that inflammation is at the core of a large range of condition from dementia, depression, autism, ADHD, and even aging. Elie Metchnikoff (1845-1919), an intelligent Russian zoologist was among the first to report that we have no control over the complexities of cellar biology and “macrophages” could go haywire and attack a physically fit well- nourished body at any time causing cancerous growth and tumors.
There was a portion of the book that highlighted the latest findings of scientific technical study of immune biology and research, though Ehrenreich tried to keep the material as interesting as possible.

Heath wellness and productive aging books lead the best-seller lists. Celebrities promote their own vital health websites that feature pricey healthcare supplements and foods, skin care formulas, fitness and exercise gadgetry and a variety of other products. Ehrenreich was quick to point out that the cultural obsession with youth and beauty leads to levels of extreme self-absorbed behavior and entitlement of wealthier people—who have the luxury of time and can afford costly procedures and surgery to alter their appearance and combat aging. Lower income people are often socially judged and criticized for their low motivation, poor diets and lack of exercise.

The pressure to remain physically fit and in full control over our health continues into old age. We are encouraged to maintain a healthy diet, sleep schedule and exercise. Our profit driven health care system promotes diagnostic testing and screenings. Ehrenreich, (1947-) has a PhD in cellar immunology, received a breast cancer diagnosis in 2000, and later a false-positive reading after an MRI; elected to have reduced or no further cancer screenings.
To ease the suffering related to stress and anxiety among cancer patients an NYU psychiatrist uses psilocybin or magic mushroom treatments. Depression and anxiety were eliminated and patients lost the fear of death, tripping under watchful medical supervision while experiencing a mystical connection with the universe. Clearly, further studies in this area will be beneficial not only for cancer patients but others as well. This is quite an informative read as Ehrenreich reminds us how little control we have over the aging process and the medical conditions that could impact our lives. ** With much appreciation and thanks to Twelve- Hachette Book Group via NetGalley for the e-Galley Edition for the purpose of review.

[Jessaka · Rating 1 out of 5]

What I did not like about this book is the fact that she not only states that she is an atheist but she puts down religious views in the beginning and towards the end of the book. I just do not believe the science and religion should be mixed in this way, and I believe this book is gonna be a put off for anyone who is not an Atheist.

If I have this concept correct, we die because our immune system attacks us. If god had created us, he did allows you job. But she doesn't say this instead she says that the evolution of our body is not that great or good. This to me would be a put off for anyone who believes that are creator designed us beautifully.

In her last chapters she says that we do not have a soul because no one has seen it. She also states that positive thinking doesn't work.

,
This was very depressing. You may as well eat, drink, and be merry for tomorrow you will die.

[David Wineberg · Rating 5 out of 5]

The Reductionist is IN

With too much time on our hands, we are obsessed with ourselves. Barbara Ehrenreich visits the catalog of diets, wellness, mindfulness, religion, movements, medicine and idiotic fads that preoccupy so many. Eternal youth, eternal life, and managed death are all symptoms. Taking the view from above, it is of course of no moment in the ongoing universe.

We want to think we can beat the odds and maybe even death. Certainly deterioration is ripe for conquering. So we work out, eat “right”, supplement and moisturize. And if we deteriorate, it must be our own fault. Between the fads, the trends, the diets and the studies, “every death can now be understood as suicide” she says in Natural Causes.

It begins with a jaundiced look at preventive healthcare. We insist on too many pointless checkups, too many pointless surgeries and too many pointless drugs. It has become a “ritual” that doctors perform for our comfort. That doctors have begun having themselves tattooed with “DNR” (Do Not Resuscitate) is a clue how extending life a few days or weeks in intensive care is of little benefit.

The book is a total pleasure of clear thinking, precision word choice and sober reflection. All of it relatable. Her thoughts are our thoughts, her appreciations our appreciations. Validated and justified and rationalized. Her job has been to collect it all here, and reduce it to its true value and worth. The conclusion she comes to at the very beginning is that life is just a short pause in the ongoing processes of the universe, so don’t torture yourself, and enjoy it while it lasts.

David Wineberg

[Ell · Rating 4 out of 5]

What an illuminating and thought-provoking book! Author Barbara Ehrenreich poses a seminal question. How much time and effort should we devote to pursuits to extend our lives? The answer, it turns out, is less than we have been led to believe in recent years by the ever growing and exceeding profitable “wellness” industry. The book presents an antipodean view based on scientific evidence which depicts a more dystopian understanding of the body. A view, I would argue, that was already highly accepted by past generations. Some may see this book as cynical because Ehrenreich unabashedly examines so many things we have come to accept as truths and practical medical routines. However I find in many instances it is simply critical thinking at its best. I am a staunch supporter of encouraging critical thinking; for this reason, I give this book 4 stars.

[Kirsti · Rating 5 out of 5]

Splendid, precise, no-bullshit assessment of which age-prolonging techniques are worthwhile. Ehrenreich has no tolerance for victim blaming. Her Ph.D. in cell biology serves her well.

In short: eat more vegetables, exercise, expect some pain as you age, and don't assume that health professionals always know what's best. Keep an open mind, do research, and think carefully before committing to an operation or other procedure (or even the latest diet craze). Understand that the longest life may not be the best quality life.

[Kaethe · Rating 3 out of 5]

Uneven. Some excellent points and some nonsense. Mostly there's an unexpected level of credulity about weird stuff, and some strange places where she seems to miss the point entirely.

Not up to the standards she has set with Nickled and Dimed, but not a waste, either.

Library copy

[Deb (Readerbuzz) Nance · Rating 3 out of 5]

Barbara Ehrenreich, who has bravely taken on minimum wage in her classic book, Nickel and Dimed, now takes on all the buzz-worries of my Baby Boomer generation in her book, Natural Causes. I was fascinated with her take on screenings and annual exams: unnecessary, all. This is not just her opinion, mind you; this is what science is telling us. Fascinating. And why haven't I read this before now?

Probably just me, but I loved this sentence: "Once I realized I was old enough to die, I decided that I was also old enough not to incur any more suffering, annoyance, or boredom in the pursuit of a longer life." Amen, sister.

I was intrigued by (but not entirely clear about, to be frank) the role of macrophages and inflammation and the body's own immune system in some of the biggest problems to our health. I would love to read more about these.

I was not as taken with chapters on mindfulness and cells. These felt like they were tossed into this book to beef it up, size-wise.

And, as much as I agree with her with her social system rants, they were rants, and I felt like these took away from her scientific approach to the book.

Overall, then, I liked it, but I didn't love it. I'd say to read the chapters you like and skip over the parts you don't.

[Hank Stuever · Rating 4 out of 5]

An enjoyable -- if prolonged -- tract from one of our last, true, highly regarded crabs. And just the thing for a certain reader facing 50.

I've been reading Barbara so long I feel like I'm on a first-name basis with her. I almost always agree with her clear line of thought and her mistrust of all the B.S. directed our way from all directions. She'll be forever known for "Nickel and Dimed," but I think she's fought the longer game against a more pervasive undermining of the human spirit, which was fumigated to death by the so-called power of positivity. Barbara knows: Everything dies, even the most balanced of us will die. Yet we've built a health-care and wellness system that deliberately roots around for ways to make us more miserable in the futile pursuit of immortality. She's right again -- and this time, reading her, I realized how low we're running on useful cynicism, grumpiness, etc. True intellectual criticism has been replaced by flashes of Twitter outrage. Keep at it, Barbara!

[Noël · Rating 1 out of 5]

1.5. This book is all over the place. If I could sum up - we all die regardless and she's mad about it, so she's blaming medicine and science. Side trip into her anger at the immune system for not fitting the pattern of "good" she wishes to assign and pearl clutching over what is essentially chaos theory as seen in biological systems. The part on macrophages was interesting and garnered the 1.5 stars here.

Basically, Barbara sounds like Grandpa Simpson ranting. She starts out with a premise that makes sense but by the end she's ranting about how nothing is how she clearly expected it to be. It's more a polemic of how life has disappointed her and look at all the anecdotes. It also is all over the place.

Facts
1. None of us gets out alive
2. Screws fall out, it's an imperfect world

Getting mad about 1 and 2 and throwing a book long tantrum about it is pointless.

[Robyn · Rating 4 out of 5]

Ok, I have a shelf for death books, those that academically discuss death and its accompanying accudiments... this fits there well. (I would like to thank Mr. French for the accudiments word... if you know who that is, then you are old enough to die naturally!)

I thought the book was super informative and certainly illuminating. I have to agree with so many of her observations and the changes in our society as we enter the age of increasing levels of narcissism. The book is in support of living your life as well as you can without working at living well like a 24/7 job. The old adage of, eat well, exercise and die or ---- live well, eat healthily, get up and move around and die. So, clearly ... die is the outcome of either one of the choices. I guess you have to identify where you are on the age scale. I was a gym rat when I was younger, and now I just have a membership... literally, I don't go, but I could if I wanted.

Ehrenreich broadens the scope of her review with each chapter, talking about the medical field and how it thinks about you, the world at large.. including religion, holistic medicine and so many things that I was a bit adrift for a while. I do agree that we have become a society focused on ME, me staring in my life, the center of my life, and only my life will do... I am not sure about using psilocybin to change this attitude, but if it would help... maybe.

There is so much more that goes into who gets to have a long life than just trying to live well.

I was the caretaker for my parents. I admired both of them when doctors would suggest various tests and procedures, as they both always asked the doctor if he understood they were at the age they were, and that none of that foolishness would be taking place. After all, when you are 90, is there really any reason to do a stress test? They didn't think so.

This was a fresh and interesting read on a view about life (or the rest of mine) that I am quickly coming to share. Good points and a good read!

4 stars

Happy Reading!

[DilekO · Rating 5 out of 5]

4 ile 5 yıldız arasında kaldım. Sağlıklı olma takıntısının artık hastalığa dönüşmeye başladığını düşünen biri olarak kitapta bu konuda araştırmalar yapmış ve sıra dışı bir bakış açısı geliştirmiş birinin fikirlerini okumayı çok sevdim. Biraz daha tarafsız olabilsem 4 verirdim herhalde .

[Rob · Rating 2 out of 5]

NATURAL CAUSES: AN EPIDEMIC OF WELLNESS, THE CERTAINTY OF DYING, AND OUR ILLUSION OF CONTROL
By Barbara Ehrenreich
Grand Central Publishers, 257 pages
★★

There is a scene in the movie A Ghost Story in which an earnest young man expounds upon human vanity and the meaningless of humanity within the cosmos. Nothing will endure, he notes, not great art, individual achievement, reputation, or the solar system itself. We all die and at some point the sun will flame out, the galaxy will implode, and all trace of our existence will disappear. Around him women attend to babies, food is prepared, beverages are consumed, and life goes on. A few bemusedly nod—not because the messenger is wrong, but because what can anyone do with that information? A cynic might view Barbara Ehrenreich's Natural Causes in the same light. Alas, she invites such a reading.

There are few non-fiction writers whom I admire more than Barbara Ehrenreich but I must ask what we are supposed to do with what she tells us in Natural Causes. It's a depressing book, and perhaps also be a dangerous one. Ehrenreich, 76, reflects upon aging and death from the perspective "that I am old enough to die … [and] old enough not to incur any more suffering, annoyance, or boredom in the pursuit of a longer life." Ehrenreich has sworn off such things as annual physicals, pap smears, mammograms, cancer screenings, and bone density tests—most of which, she avers, are irrelevant because they either reveal false readings or irreversible fates. She is exceedingly critical of wellness movements, including the gym culture of which she is a devotee by choice, though she does not believe it will yield a longer or healthier life. If you think she's ruthless on that subject, you're not going to like what she has to say about yoga, running, diet fads, mindfulness, supplements, or mind-body dualism—most of which she sees as utter hokum. Long-time Ehrenreich readers will recognize her takedowns as medicalized versions of her autopsy of positive thinking in Bright-Sided (2009).

Her very chapter titles tell you what Ehrenreich thinks of the medical profession and disease-prevention and life-prolonging alternatives: "Rituals of Humiliation," "The Veneer of Science," "Crushing the Body," "The Madness of Mindfulness," "Death in a Social Context." Ehrenreich is in full muckraker dudgeons in these sections and occasionally lapses into ad hominem attacks or slips into anecdotal evidence. She notes, for example, that running guru Jim Fixx died at 52, author John Knowles—who wrote books on living past 80—also perished at 52, that a vegan diet didn't help Steve Jobs, and that women's fitness center mogul Linda Roberts died of lung cancer though she ate healthily and never smoked. By contrast, Jeanne Louise Calmet lived to 122 after having done lots of things contrary to medical advice. Sure, but these are outliers and all of them would have been marvels a hundred years ago when the average age at death was 49.

The heart (if I might) of Ehrenreich's book comes when her voice shifts from rant to science. She has a Ph.D. in chemistry and can discourse with great intellectual heft on matters such as stochastic noise, lipids, beta-amyloid plaques, neutrophils, macrophages, and inflammaging. In these sections—the bulk of which occur in chapters titled "Cellular Treason" and "Tiny Minds"—she offers a "dystopian view of the body," and that's putting it mildly. The same immunity mechanisms that help fight disease will, in some circumstances and in general as we age, switch from helpful to harmful. Don't look for balms; Ehrenreich clinically observes, "The survival of an older person is of no evolutionary consequence…. [The] diseases of aging clear the clutter of useless older people." Nor is human free will unique. Ehrenreich walks us through studies that show that atoms and cells demonstrate decision-making properties that coordinate human demise.

Only toward the end of her book does Ehrenreich gravitate toward anything remotely cheerful. It's not religion; she sees far more evidence for black holes than for a soul or a deity. Her prescription is to live as joyfully as one can, surrender to the inevitable, and obliterate the self—the last of these her take on the Buddhist concept of ego death. Your life, memory, and works will disappear but the things that made life worthwhile—sunsets and nature, for instance—will continue for a long time. In the final moments, the self can be suppressed through hospice, painkillers, psychedelic drugs, and (in some places) doctor-assisted suicide.

So, again, what do we do with such messages? I haven't the foggiest idea; death, like birth, is a mystery in which we are unwilling participants. I worry, though, that Ehrenreich refracts too much through her own intellect. Most people don't have a Ph.D. in chemistry and cannot make equally informed decisions about their care. Moreover, much of what she condemns suggests that we need better medical care, not less, and greater oversight in determining best practices from ineffective ones. In the same vein, we certainly need stronger regulations to curtail false claims, hucksterism, and the peddling of latter-day snake oil and electric belts. And I really must caution against a cursory reading of this book, lest one conclude there is no need for medical screening. I know women who are alive because of mammograms; Ehrenreich is one of them. In the end, though, there's no getting around the fact that Natural Causes is such a downer that one could come away with the message of: eat, drink, and be merry for tomorrow we will die. Unless you're poor—then it's life sucks and then you die, a thesis Ehrenreich advances. Maybe all we can do is go on with the party, come what will.

Rob Weir

[Melinda · Rating 4 out of 5]

Barbara Ehrenreich turns commonplace medical and scientific assumptions on their head in this fascinating, far-reaching exploration of how we understand health. From the immune system's role in causing — not fighting — cancer to evidence of "cellular decision making," she breaks down recent scientific discoveries, exploring their philosophical and practical implications. With a dizzying scope, the book touches on the politics of medicalized birth, the absurdity of corporate wellness programs and the secret lives of macrophages. It's an engrossing read, packed with stories, quotes, statistics and echoes of her earlier works, including Witches, Midwives, & Nurses (which I've read) and Living with a Wild God (which I haven't), not without essential feminist and class-conscious analysis.

Highly recommended, whether you're a biology nerd, interested in the philosophy of science or just looking for another reason to skip your next annual medical exam.

Note: I received an advance reader's copy of the book through NetGalley.

[Biblio Files (takingadayoff) · Rating 4 out of 5]

Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer starts out in fine Barbara Ehrenreich form, expanding on the lengthy title to skewer the longevity industry (eat yogurt/do brain games/join a gym), and the medical professions as well, as they become more and more focused on providing more services that can generate profits than on services that will actually do the patient any good. Then the book becomes more scientific as Ehrenreich, who has a background in the biological sciences, delves into the latest cancer science and more. I found this section challenging and frankly, was not able to keep up at times. My background is not in the sciences, unfortunately. Then the book finishes up in a philosophical mood as Ehrenreich ponders the nature of death and the futility of attempting to live forever. For all the talk of death and dying, Natural Causes is not a gloomy book, and there's something here for just about any reader, whether you plan to die or not. (Thanks to Twelve Books and NetGalley for a digital review copy.)

[Laurie · Rating 2 out of 5]

Disappointed. I really liked two other books that this author wrote but found this one to be somewhat of a rant against our culture (not that I disagree). She gives us lots of information but somehow it didn’t seem to all tie together into anything, so I found myself skimming faster and faster until I just had to put it down, which I regret because I’m thinking there might have been something interesting hidden in there...somewhere.

[Grace · Rating 4 out of 5]

I received an ARC from https://www.pagesabookstore.com/ because I sometimes write shelf-talkers for them. This is my honest review that I am sending them.

I'm a Barbara Ehrenreich fan, but I think that many readers would be better off if they skipped chapters 1-5. It's a repetitive polemic, especially for people who have already read her earlier book, Bright-Sided. Making fun of GOOP is like shooting fish in a barrel. If you keep up with the news about evidence-based medicine, you won't learn anything new, but your blood pressure will spike.

I would recommend reading the Intro, and then skipping to Chapter 6: Death in Social Context. As explained in the intro, Barbara Ehrenreich is also Dr Ehrenreich; she earned her PhD studying immunology and macrophages.

She really hits her stride in chapters 7-9, describing the science of immune systems behaving badly.
T-cells, monocytes and macrophages...Oh, my!

Chapter 9: Tiny Minds reveals that cells do not behave deterministically; cells with the same genetics and the same environment may behave differently. She made a spot-on analogy to the quantum two-slit experiment.

She closed the book with some thoughts on 'Successful Aging' that are not the ones you might read in Shape magazine. There are things that we can not control. We can follow best practices to improve our odds, but they are odds, not guarantees.

A longer life is not a better life. The experiments that significantly prolonged the lives of mice required starving them as much as possible without actually starving them to death. A longer and miserable life is just more misery. I'll have dessert, thank-you.

Death is inevitable. How you deal with it is not set in stone. The people who have made the most peace with it are comfortable with what they have achieved (not riches or fame) and what they leave behind.

If you read chapters 6-12 of this book, you will learn a lot of science and gain some wisdom. It is a good investment of an evening's time.

[Katie · Rating 3 out of 5]

Natural Causes was a book I needed right now. I had recently read an article excerpted from the book arguing that the cons of preventive screenings can outweigh the pros and that we should concentrate more on enjoying living than trying to live longer. Even if you do everything right like eat well and exercise, that doesn’t guarantee good health to an advanced age. The book goes more into detail on the science behind how our cells age and how our immune systems can attack our own body. Then the book delves into the whole nature of “self” philosophically. That part was less useful to me. My overall take-away was moderation and living well. Don’t get so much medical and preventive care that it outweighs your joy in living because we have an illusion of having much more control of our health than we really do. I received an advanced reading copy through NetGalley for my unbiased review.

[Stacey Camp · Rating 4 out of 5]

**4.5 Goodreads Stars**

"In the health-conscious mindset that has prevailed among the world's affluent people for about four decades now, health is indistinguishable from virtue, tasty foods are 'sinfully delicious,' while healthful foods may taste good enough to be advertised as 'guilt-free.' Those seeking to compensate for a lapse undertake punitive measures like fasts, purges, or diets composed of different juices carefully sequenced throughout the day.

I had a different reaction to aging: I gradually came to realize that I was old enough to die, by which I am not suggesting that each of us bears an expiration date. There is of course no fixed age at which a person ceases to be worthy of further medical investment, whether aimed at prevention or cure."

Have you ever struggled to get a medical diagnosis? Been told that you aren't sick or been dismissed by a doctor? I am guessing most people at some point in their lives have experienced this frustration, and while Barbara Ehrenreich's Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Our Illusion of Control isn't specifically about misdiagnosis, it's about the many problems involved in the healthcare industry. 

Some people have written about this book as though it's merely about deciding not to have preventative care once you reach a certain age, but that's only part of the picture. Ehrenreich takes on the health industry full stop, debunking the myths that manage to still dictate patient care and revealing the industry as it is, which is that it is a business. She also unravels the wellness and mindfulness industry that pervades America right now, which severely lacks evidence to support its claims. 

What I came away with after reading this book is that medicine (and the mindfulness industry), while wonderful and helpful, is still in the dark ages on certain issues, such as the immune system. We still have a lot to learn about how the immune system compromises and interacts with the rest of the body. The book also made me feel less responsible for what happens to my body, because sometimes you can do all of the right things that society tells you to do - exercise, eat well, meditate, etc. - and still end up with a body that turns on you. As Ehrenreich states: 

"What is the point of minutely calibrating one's diet and time spent on the treadmill when you could be vanquished entirely by a few rogue cells within your own body?"

I like that Ehrenreich explores both the business side of medicine as well as how our culture pushes for control over one's body. Controlling one's body has become a business, whether it is one's looks, one's weight, or one's health. It's not just the medical industry that is trying to create more tests and interventions to prevent the inevitable - death - but it is also patients demanding more testing. But Ehrenreich does not see value in subjecting herself to more testing that has no evidence to prolong people's lives when they get to old age. She writes:

"I reject the torment of a medicalized death, but I refuse to accept a medicalized life, and my determination only deepens with age. As the time that remains to me shrinks, each month and day becomes too precious to spend in windowless waiting rooms and under the cold scrutiny of machines. Being old enough to die is an achievement, not a defeat, and the freedom it brings is worth celebrating."

Her reflections, of course, only apply to those of us healthy enough to not need regular prescriptions. It does not apply to people with chronic health issues or those who have been and are sustained by medicine. I personally know I could not get my inhalers - which I rely upon twice a day to breathe - without seeing my asthma doc at least once a year. 

This review barely scrapes the surface of this book. There is so much good information here and so many thoughtful discussions about healthcare, medicine, and culture in the Western world. I think I highlighted half of the book. This is one of those books that will have a permanent place on my bookshelf for years to come (as is the case with Ehrenreich's other publications!). Thank you to the publisher, the author, and NetGalley for an advanced reader copy of this book!

For more of my book reviews visit me here:
Book Review Blog | Twitter | Instagram

[Emily · Rating 1 out of 5]

DNF at 50% in. This book had an interesting premise but ultimately seemed to be just a series of essays railing against pretty much everything: traditional western medicine, alternative medicine, fitness activities, good nutrition, and who knows what else, as I just couldn't take the author's negativism any longer. She declared herself too old to continue with health screenings, yet "too young" for yoga, which is ridiculous. She railed on all kinds of "healthy" diets, maybe to justify her Wendy's habit. She seemed to condone smoking, as it is "comforting" for "lower-class people". Yes, we're all going to die one day, but why not make the most of the days we have here on earth?

I'll be 60 next month and feel sure that my (mostly) healthy diet, daily walks, bicycling, and other activities have at least something to do with the fact that I don't have diabetes, high cholesterol, heart problems, cancer, obesity or any other illnesses that tend to plague so many older adults in the U.S. I tried to keep an open mind as I read this, and some of her points were well taken, but I am not willing to just throw all caution to the wind since I'm going to die of something, some day anyway. I have no idea what she thinks of the COVID vaccine, but from reading the first half of the book, I wouldn't be at all surprised if she were an anti-vaxxer.