Ehrenreich, as always, turns in a prescient and finely-crafted book that marries recent scientific knowledge to accessible and elegant writing in exploring the medicalization of aging and those who seek to reject the prolongation of life at the cost of living well.

I was disappointed in this book. The author has written other things which I have respected and enjoyed very much. This book seemed not to be well thought out, and sometimes vindictive and sarcastic. Some of her points are likely valid, but instead of backing them up with facts and reliable resources, she came off as bitter and one-sided. I hope there are more books coming from her which compare to her earlier writings.

"You can think of death bitterly or with resignation, as a tragic interruption of your life, and take every possible measure to postpone it. Or, more realistically, you can think of life as an interruption of an eternity of personal nonexistence, and seize it as a brief opportunity to observe and interact with the living, ever-surprising world around us."

This book is very hard to pin down. I had many people asking me about it while reading it, however i never had the words to fully describe it. There was definitely a lot of content and it was really informative with a lot of great opinions put forth by Barbara Ehrenreich. However, it felt essentially directionless. Ehrenreich is definitely knowledgeable, especially in her professional concentration of cellular biology. This made the second half of the book a lot more enjoyable as a scientific review rather than a testament to how we should live. As a personal trainer/nutrition enthusiast/former kinesiology student, her stance on health and wellness seemed extremely uninformed. Yes it is definitely overblown and turned easily to quick selling propaganda, but to dismiss the importance of a balanced diet (see: not restrictive or absent of indulgence) and a consistent physical activity is a bit foolish. I loved a lot of the book, but it had such a pessimistic and disdainful undertone that it read largely as opinion than evidence based thoughts. Her chapters on reproduction and an "over-doctored" society were definitely what made this book interesting for me. I'm interested to see what her other books are like seeing as they seem to be much more acclaimed.

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.

A fascinating dive into a cultural obsession with quote-unquote health, life - and prolonging it despite knowledge of the inevitability of death. Ehrenreich explores the ways in which individuals are both explicitly and implicitly coerced into needlessly putting themselves through greater (and sometimes painful, or disturbing [read: excessive colonoscopies]) trials and tribulations all in the name of quote-unquote health, or some promise of a morally-superior lifestyle.

The book is thought-provoking, and forces readers to examine the ways in which we have been taught to view the notion of health through messages dictated - and occasionally just manufactured - by the medical establishment and other authorities and institutions of power for reasons other than our global population's actual well-being.

If you can get through some of the jargon-heavy chapters, regardless of how open you may be to reflecting on your own health behaviors or those you may instill upon others - it's an interesting, well-researched read.

This was an interesting argument about what it means to be a body, a self, and a person trying to interact with the medical industrial complex. I'm certainly intrigued to read more from the author in the future, particularly some of her most notable works (e.g. Nickel and Dimed, etc.). That being said, I think this book would have done better as a more focused work of essay or article length. As is, it feels somewhat unfocused.

"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!

Barbara Ehrenreich: Natural Causes
You should probably not read this book if you are a hypochondriac or get nervous learning unfortunate medical facts. Ehrenreich shares some alarming information in Natural Causes. Information like: at any moment macrophages, a vital part of the intricate and bizarre system within you which is supposed to keep you healthy may instead decide to betray you and actively encourage the growth of cancer.

You may remember Ehrenreich for Nickel and Dimed, a book from several years ago which detailed her reasons why no one can survive on minimum wage.

But back to your body trying to kill you.

The book is full of truly unsettling statistics and pronouncements. We learn that many doctors only give you an annual physical because you would be outraged if they told you such exams are pointless. We learn that some experts believe that current medical technology is so highly sensitive that we are detecting and surgically removing, or treating with dangerous chemicals, growths that are either entirely benign or would have gone away on their own. Fun, right?

Never believe 100% of what someone tells you without checking into it a bit first. And I'm not referring to the medical industry right now, I'm referring to the author. I would have had a lot more faith in her view if she hadn't said right off the bat that despite being a breast cancer survivor, she has now given up mammograms because she would rather not experience the stress of false positives. She is now in her upper 70s and I get it, that's not young. But to say that you are more comfortable with dying from a treatable disease than undergoing uncomfortable and potentially stressful tests every now and then is a bit worrisome. So while a lot of what she has to say is perfectly accurate and definitely food for thought for anyone who wants to keep themselves healthy, don't let her talk you into skipping your checkups without considering what that could mean for you.

In addition to the sometimes questionable view of medicine, the book ends up jumping around to a few different topics. By the end of the book, it's become about the "self" and whether or not humans have a spirit separate from their bodies. One of the things that bothers me the most when reading is to come across someone who has decided they are too smart for religion. Ehrenreich tells us that the Bible never mentions an immortal soul. And sure, she's not the only person to smugly point this out. But if such stubborn literalism is all you can scrape up to say on the matter of Christianity vs. atheism/agnosticism/science/blahblahblah, then you are simply choosing to ignore the entire message of the New Testament. Or are you maybe just not that smart after all? This is like saying Louisa May Alcott didn't care about the rights of women because she never used the word "Feminist" in Little Women. Go ahead, I have a bridge to sell you.

And let's not forget the fact that Ehrenreich thinks there is no reason doctors should be forced to learn how DNA and human cells work. Call me crazy, but that's something I don't really mind my doctor understanding. Otherwise it seems like a slippery slope to him telling me my humors are misaligned and I need a good leech treatment. What next, my mechanic will tell me to get an oil change or else the gnomes that make my engine work will be unhappy?

But at the end of the day, the premise of this book is not wrong. You can eat a vegan diet, exercise 6 days a week, and still drop dead of a heart attack or get cancer or get hit by a bus. And then there are people like George Burns, a man you can't even picture without his famous cigar, who lived to be 100. Guess he had good macrophages.

I received my copy through NetGalley.

Rating out of 5 stars: A surprisingly high 3 1/2

Barbara Ehrenreich, the author of Nickel and Dimed as well as other books, is in her mid-70s and has abandoned preventive medical care. She proclaims that she will not have annual exams, mammograms, Pap smears, etc. because she does not want to extend her life with agonizing testing and treatments. Ehrenreich explains that she has reached an age that she is “old enough to die,” but will seek help if she experiences an urgent problem. I wonder if she has considered that there are some treatments that are not tortuous and/or the actual condition may be more painful.

The central tenet of this book, in my opinion, is about the quest for control and who or what will be victorious. Control seems to be the lens through which Ehrenreich sees everything, including her own health and well-being.

We are able to control many things about our bodies - weight, fitness, shape, and emotions. We can even exert some control of our bodies through our minds. But there are some things that are beyond our control.

In the Introduction to the book, Ehrenreich proclaims that she does not prescribe to the theory of the body as a well-running machine. Rather she believes in a dystopian view of the body in which there is cellular conflict, which we cannot control.

Ehrenreich did her graduate work on macrophages, which are cells that are the body’s defense against bacteria invaders that can cause disease. However, as we get much older, the macrophages commit “treason” and actually help the enemy. Not only do they help cancer cells move to other parts of the body, they facilitate the creation of blood vessels that feed the tumor. Thus, our immune system eventually turns on us and becomes the enemy.

“... the immune system actually abets the growth and spread of tumors, which is like saying that the fire department is indeed staffed by arsonists.”

The fight for control extends beyond our own self. The doctor exerts control over the patient and this is perhaps most extreme in the case of the gynecologist and the female patient. Ehrenreich lost me here when she claims that gynecological exams are an assault on women’s bodies because they “...so closely mimic actual sexual encounters.” She claims that these exams (or as she puts it “...regularly scheduled invasions of privacy”) are essentially worthless and run the risk of false positives and potentially unnecessary surgeries. Ehrenreich goes further citing support for her view:

“In 2014, the American College of Physicians announced that standard gyn exams were of no value for asymptomatic adult women and were certainly not worth the ‘discomfort, anxiety, pain and additional medical costs’ they entailed.”

These views really disturbed me because I believe that Ehrenreich’s pronouncement is very misleading and dangerous. I went and looked at this report and discovered that they are only referencing the pelvic exam. First let me say that there is more to a gynecological exam than just that. For instance, an important and essential part of the visit is the Pap smear — it is extremely effective at detecting ovarian cancer in women who don’t have symptoms. In addition, Ehrenreich and this report do not mention that the American College of Obstetricians and Gynecologists continues to recommend that the pelvic exam be conducted annually on all women 21 years of age and older even though admitting that the evidence of its usefulness is inconclusive. Clearly more research is needed to determine its efficacy and that is what’s recommended in JAMA, the Journal of the American Medical Association.

Next, Ehrenreich takes on the fitness culture, the benefits of mindfulness and the usefulness of wellness programs. This is really all about the mind and it’s control the body. All of these discussions are interesting and worthy of more thought and consideration. But when she talks about cellular treason in Chapter 8, the level of biological detail can make some readers’ eyes glaze over. While the research for Natural Causes book is extensive, we are unable to determine how thorough it is. As I read this book, I found myself repeatedly wondering about the research that is not presented because it does not support Ehrenreich’s thesis. It was clear she has her own point of view and that this is not an objective presentation.

Thank you to Twelve Books and NetGalley for a copy of this book in exchange for my honest review.

The author explains how, at a cellular level, all the health fads, products, and procedures that are marketed as "anti-aging" really do not work. Regardless of what we do, biologically our cells are programmed to act certain way and, at least for the moment, there is nothing we can do to stop or reverse their process. The book starts off strong but wanes in a couple of parts. Overall it was very interesting.

People over fifty-five are now the fastest-growing demographic for gym membership. Taking care of our bodies is a great thing. But obsessing over our bodies isn't necessary. Don’t feel guilty that you will eventually die.

In this book, Barbara Ehrenreich shows us we don't have to be preoccupied with physical health. Keep it in perspective. Aging is a natural process; everybody that lives long enough will experience it.

She helps us release the blame that we often get from the medical establishment, the food industry, and the stay-young-forever advertisements, to try to live forever in a pristine body here on earth.

“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.”

Ehrenreich argues against the obsession and the blame. She does not see every death as a suicide for failure to prevent itself.

While parts of the book sunk too deeply into minutiae for my tastes, overall the book was an encouraging read. It helps us understand that while we do have some control over our bodies, our lives, and our deaths, we don’t need to overly preoccupy ourselves with controlling every little thing.

My thanks to NetGalley for the review copy of this book.

Well written and full of common sense on an issue which effects us all. Looks not just at practical issues surrounding aging but at the emotional impact of a culture obsessed with trying to 'cure' every ailment with no regard for quality of life.

(2.5 stars) 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?”

I found this book very interesting as it confirmed some of my own biases. Although Ehrenreich writes about the US health system in which the profit element inevitably influences the approach to care, much of her argument applies generally and she has a sound scientific background which makes her polemic very convincing. The belief that we can manage our bodies through all sorts of interventions around diet and physical and mental exercise has led to an overwhelming emphasis on the obligation to do so, fuelling market opportunities for health entrepreneurs. It is good to read an analysis which shows the unintended consequences of this although I suspect that this may not convince many people.

The idea that our immune systems may not always work for our overall benefit and that cells within our bodies may be making their own decisions challenges received wisdom in an uncomfortable way but I find this encouraging as it demonstrates how little we actually know about how our bodies work. Advanced technology seems to disguise this ignorance and offer a solution for many medical problems. We expect a great deal from science and medical practitioners, possibly far too much.

This is a good thought-provoking read. (Thanks to Netgalley for an ARC.)

Thanks to NetGalley for this ARC in exchange for an honest review!

Natural Causes is like having two books in one. The beginning section discusses whether eating “right” and exercise will truly extend our life expectancy, or if those admonitions are erroneous. The author makes some good points, while others seem a bit dubious to me. Her writing is at times self-deprecating and humorous; other times erudite.

The second part of the book is a bit dry, as she delves into the philosophical side of what is “self”, and how we think about death and dying. There is also well written chapters about inflammation, cancer, and how we may be doomed to succumb despite positive thinking and the best efforts of our oncologists.

As a long distance runner, I felt an uncomfortable feeling as the author worked through debunking exercise “myths”. Did I agree with her or not? I agreed with the section on medical ritual, as explained by Stanford medical professor Abraham Verghese during one of his TED talks. He discusses a breast cancer patient who chooses a less prestigious facility over one with valet parking, a welcoming atrium, etc. The reason? The first facility actually gave her a physical exam, using touch and interaction. If I visit a doctor and do not get my eyes, ears, or lung sounds assessed, I feel cheated. Ritual displays, whether they are a placebo or not, satisfy and calm me. I also felt a kinship with the chapter on mindfulness and ADHD, as she discusses electronic addiction and how that is depleting our attention span.

As I read on I realized that I did not agree with her decision to shun yearly exams (her thoughts are that the doctors are “looking for problems that remain undetectable to me”). The author also discusses repetitive x-rays of the teeth, mammograms and their tendency towards false positives, and colonoscopy.

When she started noting the evidence of “overdiagnosing” due to the multitude of various health screenings available, I simultaneously agreed and disagreed. A 90-year old woman does not need a mammogram; a 30-year old should get Pap smears and yearly bloodwork.

The chapter entitled Cellular Treason was most interesting; explaining that perhaps all the steps we take to remain healthy may be for naught; our cells will do what they want regardless. It was at this point in the book that the writing became more scientific and less opinionated, and leaned towards the dry and almost dull. I rather enjoyed the cantankerous, tinfoil hat-like musings from the beginning.

Ehrenreich may be a detractor of medicine, but she is no dope. She is intelligent and can put a sentence together well. This book is certain to spark debate, which hopefully was her intent. Each chapter has the ability to appeal to a wide range of people, as well as invite criticism. I feel better prepared to face my doctor after reading it.

Want your own copy? Head over to Amazon and grab it!

I thought this would have worked better if it was presented as a collection of essays. As a book divided by chapters, I found it to be disjointed and without a natural flow. The chapters on cellular biology, a subject I actually find very interesting, felt out of place. Will recommend but with reservations.

Years ago, I read Barbara Ehrenreich’s book Nickel and Dimed. It opened my eyes to way so many people in this world live on so little money from jobs that pay the minimum wage or only a tiny bit more. A good bit I learned has stayed with me since then. When this book title caught my eye, I was definitely curious about where the author would go with this.

Ehrenreich explains about her lifelong interest in science, and how she did her graduate research on microphages which were considered to be the frontline defenders that killed microbes by eating them. That thinking has changed because now studies show they actually enable cancer to spread. Her background speaks for itself and she really does add perspective on health and healthcare. In the first chapter, she talks about all the medical tests people get as they age, turn to foods with no taste and spend a lot of time working out. Some of her information comes across as amusing, and some of it is a bit alarming. She also mentions famous people who it seemed to do everything right and then died at a young age.

At the age of 72, the author has decided that she is old enough to die. She has chosen not to spend her time on a lot of medical tests that many people her age get; she’d rather do other things. She does eat a reasonable diet that she enjoys, exercise because it makes her feel good, but she will only have something checked if she thinks there is a problem. She presents a good argument that for people her age, sometimes the cure doesn’t prolong life, it does however, make the remaining days more miserable. Obviously, each person needs to make their own decision about how much they wish to do to try to live longer. She touches on many different religious beliefs, and it does not appear that she puts her faith in any of them.

The book is filled with lots of facts about how cells work. Ehrenreich also brings up medical information from the past that has been proven wrong, and I can’t help but wonder what scientists will discover in the future. Will today’s facts be proven wrong?

Overall, I thought the book was interesting, and I learned a lot from it.

I think the pursuit of immortality is hilarious! I watch, read, and hear about the nonsense on a daily basis. People just can't believe they will die someday. I run into too many kids who are being taught that they are immortal for not not smoking, not drinking, not doing drugs, not whatever, and they won't die! Too sheltered??? Take the kids to funerals and teach them what death is, honestly. People are only going to live as long as they are going to live. genetics plays a big role- no one in your family has lived much past 60? No matter what you do, your're not likely to live longer.
I thought this book was a pretty good assessment of the times. Enjoy your life while you can and live your dreams to the best of your abilities. It goes by way too quick.

I read 20% of this book. It could not keep my interest. There were interesting portions, but overall it seemed to drag and go off on tangents.

https://www.goodreads.com/review/show/2314437390?book_show_action=true&from_review_page=1