Life is too precious to worry about death

Natural Causes. By Barbara Ehrenreich. Twelve; 210 pages; $27. Granta; £16.99.

A FEW years ago Barbara Ehrenreich stopped going for check-ups. The decision to forgo cancer screenings and physical exams has set her apart from her friends, whose calendars are full of doctors’ appointments and whose cupboards are crammed with supplements and medicines. But as the American writer, who is 76, explains in “Natural Causes”, once she realised she was “old enough to die”, there was no good reason to live a “medicalised life”. Her remaining time is “too precious to spend in windowless waiting rooms”.

Ms Ehrenreich is no anti-science hippy. She will go to the doctor in an emergency. The author of over 20 books of social commentary, including “Nickel and Dimed”, an acclaimed account of poverty in America, she has a PhD in cellular immunology.

What angers her is the “illusion of control” sold by the “medical-industrial complex”. She skewers the fads that promise eternal youthfulness, such as celebrity-endorsed “radio-frequency skin-tightening”, and bossy books on “successful ageing”. But she argues that mainstream procedures such as cancer-screening are oversold as well. One study published in 2012 by the New England Journal of Medicine estimated that from 1976 to 2008 over 1m American women received a diagnosis—plus painful treatment—for tumours that would not have led to clinical symptoms.

Yet “Natural Causes” is more than a rant about snake-oil salesmen. It is an eclectic, if scattershot, musing on attitudes to life and death. These have changed hugely since the pre-modern era, as other writers have noted. In a seminal book about Western attitudes to mortality published in 1974, Philippe Ariès, a French historian, argued that before the 18th century death was rarely resisted. Life expectancy at birth hovered at around 30. Since Christianity taught that time on Earth was preparation for the afterlife, and that God decided death’s moment, you might as well do good works in the meantime.

Thanks to the wonders of science and economic growth, life expectancy in rich countries is now more than 80. Death is generally less capricious and sudden. Concomitantly humans are far less likely to see themselves as helpless against the grim reaper. Doctors have ousted priests as the anointed experts in mortality. Spin classes have replaced the sacraments.

For Ms Ehrenreich, the notion that humans can master their bodies is flawed and dangerous. Disease will strike everyone eventually. As Philip Roth wrote in his novel “Everyman”, “Old age is a massacre.” Equating health with virtue, she adds, means that the rich, who may spend $100 per hour on fitness regimes, look down on obese people as incapable of self-control, when they may instead lack education.

In one of the book’s more interesting digressions, Ms Ehrenreich argues that the idea of self-mastery is misguided since it stems from a misreading of biology. Articulating her “dystopian view of the body”, she rejects the concept of it as a well-oiled machine. Instead it is a battleground. She emphasises new research in immunology that suggests different cells are often in conflict with each other rather than working in concert. Macrophages, often seen as biochemical binmen which circulate gobbling pathogens, can help cancer cells spread—“cheerleaders on the side of death”, she calls them.

It is just one logical step from Ms Ehrenreich’s dystopian view to believing that control over our health is illusory. She urges readers to spend less time self-medicating. “Many people will find this perspective disappointing, even defeatist,” she concedes.

She does go too far. For all the false positives, screening programmes still save lives. Other tenets of preventative medicine, such as vaccines, sanitation and anti-smoking initiatives, save many more. And for most of the world, including America, a lack of health care is a bigger problem than a surplus of it. It may be easy for a well-heeled American to feel over-medicalised; less so a single mother without insurance.

Nevertheless there is a profound message buried in this survey. It is that real choice in health care must involve the freedom to refuse it.