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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.
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