In “Natural Causes”, Barbara Ehrenreich exercises her unerring talent for calling bullshit on preventive medical screening, on dieting fads and on the cult of fitness through exercise.

I’m of a cohort whose current obituaries call our demise “sadly early”, (but not "tragically early”), so I’ve got a few more years before I join Ehrenreich in being “old enough to die” (although, of course, we are *all* old enough…) I have duly documented my end-of-life wishes, and have successfully negotiated with my primary care physician a reduction in the rate of “routine” blood-testing for cholesterol et al, mammograms, and pap smears. Ehrenreich makes it clear, though, that the vast majority of screening procedures are without scientific justification, and should be called into question by patient/consumers.

Ehrenreich has more to debunk, though. She has plenty to say about the science, or lack of science supporting wellness, the belief in the body as a temple, and plenty to offer on the hall of mirrors-like reflection about one’s soul and eternity.

This is a thoughtful and thought-provoking work.

Let me start by saying I love Barbara Ehrenreich. Nickel and Dimed has been one of the formative books of my life. I was excited to pop into another one of her books when I received an advanced copy of Natural Causes, which I received in exchange for an unbiased review. Like with all of her books, Ehrenreich does impeccable research of her topic. For the first 2/3 of the book, she covers a range of topics: our worship of doctors, how some medical practices (seeped in tradition) have no correlation with actual health outcomes, and how some "healthy habits" are just practices of the wealthy and affluent. Then, things take a turn in the book as she wades into a more philosophical discussion on health. This book won't be for everyone, but many elements are helpful in thinking through how we make choices about our health.

This was interesting, and really something to think about long after you have read the book. Its well researched and I found it entertaining, also very true to life and how we see ourselves and the psychology of modern times.

A sharp examination of how we obsess on the concept of health, and try our best to outwit the laws of nature. You can count on Ehrenreich for a brilliant contrarian view of whatever she examines. Recommended!

Thanks to netgalley, for a copy of this book in exchange for a fair review.

To start, I am a big fan of Barbara Ehrenreich's work - I find her social commentary to be right on target most of the time.

This book seemed a little unfocused, however. There was social commentary - the pressure to constantly do everything possible to try to remain young (at least in appearance), the apparent attitude, frequently at least implicit, that pretty much any death is essentially suicide, since it means that you just weren't trying hard enough.

OK, but then there are chapters with a lot of very scientific information about macrophages. I think I get the point - that there are things in our own bodies that are going to prevent us from living/staying young forever, no matter how hard we try. But it was very jarring to try to put this together.

We then move on to ideas about deities and monotheism and philosophic/religious ideas about the self and what it is. Again, fine, but it felt like there were at least 3 different books being written here.

I enjoyed reading all of the individual parts, but I felt frustrated trying to see this as a unified book, with all its pieces working together to reach a conclusion. I finally stopped trying to do this, and basically treated each chapter as an article on its own. When I did that, I enjoyed the book, much more.

Natural Causes was one of the most biased books I have ever read. Even though there were things that I agreed with (such as the corporate greed of the pharmaceutical industry and how many 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 substantiated information. That was particularly dangerous considering the extreme boycotting of medical treatments that Ehrenreich promotes.

Most of the chapters ended abruptly and there was no cohesion to the book.

This could have been an opportunity to raise important discussion, but instead it drowns in condescension

I was very excited to receive an ARC of this book because it sets itself up squarely within my interests—I finished Bright-Sided: How the Relentless Promotion of Positive Thinking Has Undermined America last year and loved it, and I have been on my own similar line of thinking about health/nutrition science and medicine in the pharmaceutical era. Natural Causes continues along in the same tone as Bright-Sided, setting up a scathing critique of generally accepted and often scientifically-unfounded practice as cultural dogma, and moves forward into being quite a companionable piece with Over-diagnosed: Making People Sick in the Pursuit of Health (another worthwhile read). The book presses us to look at what we assume to be normal and healthy practice and ask ourselves if this is actually to our benefit.

In my view, this book really is separated into three parts. The first expounds upon the (lengthy) title to eviscerate the longevity industry, laying out a convincing argument that they are marketing to and profiting off of an exploitation of a fear of death and a culturally perpetuated idea that death is a disease to be cured (and that we, in fact, can cure it). This is presented alongside evidence of rampant conflict of interest in the medical field and pharmaceutical companies that profit off of our illness and convince us that they are interested in our health. Ehrenreich also neatly ties in her critiques of US cultural philosophy of “Positive Thinking” (see Bright-Sided), metamorphosed into “Mindfulness” and its close ties to “Personal Accountability”, and paints a rather grim portrait of every death being tantamount to suicide (Did she ever smoke? Did she exercise regularly? Did she take supplements? What was her diet like?). In a litany of things that are assumed to be beneficial (without evidence), the victim of a tragedy is recast as the specter of death itself.

The second, and probably the most difficult to work through, is comprised of a mere two chapters: Chapter Eight, “Cellular Treason”, and Chapter Nine, “Tiny Minds”. Barbara Ehrenreich has a history in biochemistry and did her doctoral dissertation on the topic of macrophages, and so naturally she focuses in on these little gangsters of the immune system to deftly demonstrate that science can indeed be fallible; there are things that have been considered irrefutable truths that turn out to be completely false. Indeed, those beloved macrophages, the thugs that take out the “bad” microbes that are introduced into our systems, show some propensity for autonomy and can encourage the cancerous growth that they are supposed to suppress.

One of the primary “common sense” responses to diagnoses of cancer is to boost one’s immune system using a variety of tools and techniques. What does it mean if that cancer is being encouraged to grow by agents of our immune system? What does it mean if we look at our bodies, which have largely been described as single entities with systems that work toward the health of a “self”, and see that we are in fact potentially made up of many autonomous systems that may not always succeed at prioritizing the life of the host (ill-advised for a microbe, though it may be). It sets the reader up for the next philosophical dive.

Ay, there’s the rub. Ehrenreich brings the whole book around to death, which I was shocked by because we had been flirting with the concept and yet successfully skirting around it for the whole book. I should not have been shocked. The cover gave it away right from the get-go. In the final chapters, she confronts it head-on, and what it would mean if we took a different approach to thinking about our own death. What is the purpose of upholding draconian regimes that require so much of our finite energy to cast lots against death when our own immune system, those tiny macrophages, can “decide” to turn on us at any time? Is prolonging one’s life in the face of an ever-accumulating list of age-related disabilities actually prolonging one’s “life”?

Ehrenreich dares to propose that the price of survival may not be endless toil, but perhaps just a simple acknowledgment that we may not really have a whole lot of power over prolonged survivability anyway. And also, probably most of all, it requires an acknowledgment that we do all in fact die.

This book has a very broad scope and touches upon many things that I did not address here. I am going to absolve myself of this lapse by claiming it is so as not to give away the good bits. This book prompted me to think about my own life, think about the things that I am afraid of and to look at the choices that I make for my body and myself more critically. I highly recommend it, even though there are some moments (particularly at the end) that had me in tears amidst all of the laughter (Barbara continues to show her rapier wit).

While I am a big fan of her earlier books, my interest in Natural Causes waned the more I read. I think she tried to bring into focus too many topics in one work, and ended up not treating any of them with enough detail: the nature of over-medicating disease, the conflict between religion and science, the nature of the soul, and the prevention of aging. Any one of these by itself would have been adequate: taken together, it was overwhelming.

She raises some interesting points but. overall, not my favorite from this author. I think it got too bogged down in some of the science, and I found myself losing the overall point. She does make you think about things, in this case health, in a new way though.

I didn't expect to read this book so quickly, but I felt compelled to keep flipping (on iPad) the pages to learn what else Ehrenreich had to say about living and dying. I suspect some readers will not continue reading if they disagree with some of the author's opinions about "routine" visits to doctors and dentists. I was relieved to learn there was another person who questioned why we need annual X-rays at the dentist, especially if you haven't had a cavity in over 50 years. I feel a bit guilty for stopping going to the gym, but I'd like to find a gym where people can't carry concealed weapons on the property. You certainly get an overview of macrophages and how celss work, or don't work. Since I'm a person who tends to avoid doctor unless I'm really ill, and the one who is tired of agreeing to expensive MRIs because I have dense breasts, this book shows me that I'm not alone on avoiding the doctor or endless tests, and that I am concerned about living a healthy life (the gym....), but ultimately, we are all going to die. Too bad she didn't talk knee replacements.

This book began with an important thesis concerning the many, many medical tests being recommended to us especially as we age. I agree with the author that many are prescribed without a valid need. But soon the book branched into biology that was beyond mine and many of our library readers' knowledge to follow. I'm sure for some it will be an important book, but not for the general readership at our small, rural library

I respect the opinion of the author. I still believe that doing something about my health even if I may still sick is far better than doing nothing.

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

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 as 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.

I was worried early on - it started off with a somewhat angry tone. But soon the author found her voice and provided valuable insights about the role of inflamation in our lives (and deaths), along with intelligent perspectives on exercise, nutrition, drugs, and faith, and thier roles in our living and dying experiences. I can recommend this to most readers, as it has universal (and non-partisan) themes.

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.

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.

One thing is for certain (well, two if you count taxes): none of us get out of life alive. Period. Ehrenreich builds a case for wise, life-enriching choices regarding the medical, wellness, and fitness choices we make. After all, no matter how much iron you pump or kale you eat, you cannot control your amazing and not-always-on-your-side body. Cells go rogue. Diseases happen.

This is a counter-narrative to the stay-young messages that drive people to extremes. Ehrenreich has a Ph.D. In cellular biology. Drawing on her own knowledge, current research on aging and immunology, statistics and clear examples of craziness from medical practice, dieting trends, and fitness crazes, she builds a case for ensuring we enjoy the lives we have, staying healthy in ways that make sense, trying to control only the things within our control, and pondering our relationship with aging. While some of her examples, and her own choices, are a bit extreme, there is plenty of food for thought here.

Thanks, Netgalley, for an advance copy in exchange for an honest review.

I wanted to read this book as I have enjoyed the authors other work, but this was basically a view into a dangerous opinion on how one should take care of their health. We've all go to go sometime is not always the best attitude to have about one's life. Everyone should have a healthy skepticism about needless tests but this is a bit extreme.

Starting with a humorous cover illustration of the Grim Reaper on a treadmill, this book offers a fascinating look at the way people obsess about health and their desire for control, even as we march towards the inevitable end. As Ehrenreich says, “The truly sinister possibility is that for many of us all of the little measures we take to remain fit—all the deprivations and exertions—will only lead to a longer chance to live with crippling and humiliating disabilities. As a NYT columnist observed, ‘The price we’re paying for extended life span is a high rate of late-life disability.’”

People simply cannot imagine the world without themselves. However, as the author observes, “the universe survives the death of about fifty five million unique individuals a year quite nicely.”

Whenever Ehrenreich turns her attention to a subject, I know it will be thoroughly researched and engagingly written, and this intriguing book is no exception.