Wow, what a disappointment. Perhaps my expectations were too high? I acknowledge that I expected a lot from the writer of "Nickel and Dimed", the book that changed my tipping habits in particular and my view of the life of the low-level worker in general. And the subject matter of "Natural Causes" was perfectly in sync with my circumstances: dealing with advancing age and a cancer diagnosis. My situation has been fermenting since early 2017 and by now I've come to the conclusion that my generation, the boomers, are not going to put up with the medical / pharmaceutical / health insurance industry's standard operating procedures. Instead, we were going to take charge of our lives, our healthcare, and the manner of our death.
After reading the NY Times review of this book, and hearing the author interviewed in a Slate podcast, I put in my order to Amazon immediately. I was confident I would enjoy reading somebody who was both an excellent writer and with a solid background in science, and whose views about healthcare in later years seemed to parallel my own. My hope was that along with enjoying the book, I'd be provided with arguments I could use in endlessly frustrating discussions with doctors and insurers. (Example of a frustrating discussion: I value quality of life over quantity, but my doctors take the opposite view and plan treatment accordingly. Whose opinion should prevail? Well, whose life is it, anyway?)
With my expectations at such a high level, I was all the more unprepared for a laborious, poorly researched and prepared kvetch against the medical establishment that by its weakness made the issues at hand appear overly subjective and self-centered. Barbara Ehrenreich, what has happened to you?
If wanting to be in charge of your medical treatment means you are self-centered, I stand guilty. I don't buy into the myth of the doctor as the all-knowing oracle for curing your ills, and that the patient should be a passive partner in the treatment planning process. But I wasn't ready for Ehrenreich's attempt early on in the book to demonize the medical profession, or reject doctors' advice out of hand. Her attitude harks back to man-hating excesses of early-generation feminism as Ehrenreich equates colonoscopies with sexual assault. Or, when she interprets the (always male, she asserts) gynecologist's white jacket as identifying the dominant player in a ritual where the woman receiving a pelvic exam is deliberately positioned in a receptive position. To me this is nonsense, the fantasy of someone who feels victimized by everything and who assigns absurd motivations to her supposed oppressor. In places, this author seems to have lost touch with reality.
It doesn't get better. I have no time for new-age homeopathic practitioners, so was surprised to read this Ph D's accusation that after aligning medicine with science in the late 19th century, the profession "won its monopoly over the business of healing" by deriding homeopathy, chiropractic, and other forms of quackery as "pseudoscience." But they are!
She dismisses preventive care as mostly a scam, and even though she exercises she condemns striving for fitness as just another example of our culture of narcissism. There are worthwhile arguments to be made against the excesses of medical testing and the false promises of the fitness industry, but Ehrenreich doesn't bother to make them. Instead she merely accuses, and even the logic of her accusations doesn't add up. Her sloppy writing and gratuitous arguments undermine legitimate criticism of these subjects and so do us all a disservice.
In similar fashion, she writes off the mindfulness movement to the machinations of Silicon Valley. She accuses the software developers of drumming up the trend toward mindfulness in order to sell mindfulness-related software. How she makes this connection is beyond me. I've worked in tech since the '80s and am aware there are some mindfulness apps out there, but in this multi-billion dollar industry they fail to register on anybody's bottom line, except perhaps those of a few startups. My reading of her attack on Silicon Valley is that she doesn't like the tech industry and is using the mindfulness fad to accuse the industry of manipulation. When so many far more relevant examples are available -- Facebook's use of user data for example -- her mindfulness argument is just silly. Because it loosely ties in with the book's theme she can justify its inclusion. But her argument is at best naive and at worst disingenuous.
Our death-denying culture and the industries that profit from it are worthwhile subjects for criticism, and Ehrenreich goes after them. Logically she argues that no matter how hard we exercise, how carefully we eat, how piously we avoid tobacco and alcohol, we nevertheless will end up dead. Healthy living advocates portray age and disease as personal failings that could be avoided if only we were less self-indulgent. Fair ball, but then she goes over the top and accuses "elites" in the upper middle class of depriving working-class people of their justified enjoyment of one of the few activities that reduce their stress level: smoking. Yes, she defends the tobacco industry and criticizes rising cigarette taxes that "hurt the poor and the working class hardest." Once again in this book Ehrenreich demeans valid criticism of the wellness industry by veering off the path of logic and common sense and defending the undefendable.
Her screwy logic is used against advocates of immunotherapy, a new approach to cancer that is generating enthusiasm and research -- and in a few cases, amazing success. But no, she argues, utilizing the immune system in the fight against cancer won't work because one cell type in the immune system, the macrophage, can actually switch sides and defend malignant cells from attack. With that single example she rules out an avenue of research that has only recently become viable due to advances in technology and the mapping of the genome. (In another part of the book, she wonders if much of the massive machinery used in medical treatment these days is actually fake, constructed and installed to impress and make compliant the patient.)
I don't know what's up with Barbara Ehrenreich, who is now 76. I'm a believer in Billy Wilder's maxim, "You're only as good as the best thing you've ever done." And I can attest that Ehrenreich has done some of the best investigative writing I've read. There's got to be a reason she fails so badly with this book. To get many of her zany accusations into print she must have fought tooth and nail with her publisher and her editor. I'm guessing that her previous successes and her status as a money-making author enabled her to prevail.
This book is going to do Ehrenreich's reputation no good, and may even demean some of the good writing she has done in the past. Worse, her lazy and self-gratifying arguments trivialize a major issue facing an aging America: delivery of compassionate, patient-focused healthcare to a large population, the boomers, who have pretty much had things their way so far in life.
We boomers are not going to allow our old age to be "medicalized" as Ehrenreich astutely puts it. If treatment is required, we want to know the alternatives and make the final call. This requires on our part a considerable amount of self-education about our affliction, but the internet provides us with legitimate sources of information that enable us to become "informed patients" who have earned the right to engage in a discussion with our doctors, as opposed to listening to a dissertation about what they're going to do to us next.
We've earned the right to call a halt to endless rounds of debilitating therapy and go to palliative care. And when that is exhausted, it will be our choice to go to hospice care, preferably in-home, and with the option of assistance from our doctor at the end of life so we don't have to endure intractable pain and needless suffering for weeks or months before we expire.
I'm hopeful that my generation will achieve a high quality of life through our senior years, that we'll control our illnesses rather than the other way around, and that we will learn to accept the inevitability of age and death early on, and have the authority to determine the time and manner of our death. The infrastructure is in place but attitudes of all the players need reality adjustments: We boomers must learn to age gracefully, our caregivers must learn to work with us rather than dictate to us, and the medical options as we near life's end -- palliative and hospice based -- need to be funded sufficiently to meet the requirements of our long-lived generation. All these must come to pass, and I am disappointed this acclaimed writer was unable to move the process forward.
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Customer reviews
Poorly written; what a mess of a book!
Reviewed in the United States on June 6, 2018
I love books and I love to learn (I certainly don't have to agree on every point an author expresses) but this book is NOT a good read or accurate! I've wasted too much time reading this book already; hoping I can save you some time and a few dollars to spend on another book elsewhere! This book to my knowledge has NEVER been a New York Times Bestseller as displayed on the cover! Picture of actual book cover attached.
Reviewed in the United States on June 6, 2018
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The worst read of the year -- so far -- and about a very important subject: how we boomers will age and die
Reviewed in the United States 🇺🇸 on April 24, 2018Reviewed in the United States 🇺🇸 on July 31, 2022
Reviewed in the United States 🇺🇸 on January 17, 2019
Top reviews from other countries
Wanderer75
A real help when mulling over your mortality, and that of other people.
Reviewed in the United Kingdom 🇬🇧 on April 6, 2020Janie U
Interesting opinion and I love that she speaks out but I struggled with a few of the chapters
Reviewed in the United Kingdom 🇬🇧 on September 8, 2019Ransen Owen
Points out many things I had not thought about
Reviewed in the United Kingdom 🇬🇧 on June 30, 2020
