You may view your body as a temple – particularly if you exercise ferociously, detox regularly, desist from alcohol, tobacco, sugar and all processed foods and positivity seeps out of every pore – but the indefatigable Barbara Ehrenreich has news for you. No amount of mindfulness, self-discipline and denial can spare you from your macrophages, the large white blood cells in your tissues that are found especially at the site of infection. They are out to get you. If they so choose, you will depart this world early and possibly painfully; control is an illusion.
Ehrenreich is a socialist, activist and fighter for universal healthcare, women’s rights and economic justice; she is a multi-award-winning investigative journalist and author of more than 20 books, including the seminal bestseller Nickel and Dimed: Undercover in Low-Wage USA (2001). She also has a surgically precise way with words, a sense of humour and a PhD in cellular immunology. So when, in Natural Causes: Life, Death and the Illusion of Control, she describes the civil war within our bodies that macrophages may wage – encouraging cancer cells to spread, apparently for no reason other than they can – it may persuade you to rip up your gym membership and eat nothing but cream buns for what’s left of your time on Earth. But that’s not Ehrenreich’s intention.
This book is joyous. It is neither anti-medicine nor anti-prevention; it is pro-balance, pro-scepticism and pro-perspective. And it asks us to show a little humility. The gurus of Silicon Valley may believe they can become immortal – Ray Kurzweil, AI expert, is “reprogramming” his body by taking 150 pills a day – but death always trumps self-mastery. So, Ehrenreich argues, replace isolating self-absorption and the rejection of small pleasures with a collective celebration of what life, in all its arbitrariness, has to offer.
“Once I realised I was old enough to die,” Ehrenreich, now in her 70s, explains, “I decided that I was also old enough not to incur any more suffering, annoyance or boredom in the pursuit of a longer life.”
She explains how her doctor had advised her, as an older woman, to have a test for bone density. He announced she had osteopenia, a thinning of the bones. Research revealed that almost every woman over 35 shared the complaint. Forty years ago, Ehrenreich co-wrote, with Deirdre English, For Her Own Good: 150 Years of the Experts’ Advice for Women. It was groundbreaking then and is still fresh today. Natural Causes continues in the same vein: stay sane, think for yourself.
The book was initially triggered by Ehrenreich’s diagnosis with breast cancer in 2001. The narrative she encountered then around “battling” cancer and our responsibility for what befalls us – too fat, too indulgent, too negative, “so every death now can be understood as suicide” – led her to examine the business of “wellness”. It has, she argues, led to an “epidemic of overdiagnosis” and the medicalisation of every aspect of life (accelerated in the US by the demands of health insurance) in the name of prevention and profit. Doctors applaud a woman who has her first mammogram at 100. Why? Some tests and invasive procedures do more harm than good, causing a rise in iatrogenic diseases (those caused by medical interventions and the adverse side-effects of drugs). The book gives plenty of examples: research indicates that 70-80% of thyroid cancer surgeries performed in the US, France and Italy in the first decade of the 21st century were unnecessary – 90% in South Korea, in the main because screening picked up non-malignant ailments that led to misdiagnosis.
Ehrenreich (a gentle gym-goer) questions the accuracy of much “evidence-based” medicine. As I read the book, the media reported that a large-scale international study of back pain had concluded that patients are given pointless drugs, surgery, opioids and injections when doctors should direct them to stay active. Ehrenreich quotes David M Eddy, a physician and mathematician, who reports that as a result of his research, “I realised that medical decision-making was not built on a bedrock of evidence or formal analysis, but was standing on Jell-O”. And that brings us back to macrophages.
A macrophage is the body’s “garbage collector”. It eats corpses of other cells. It is also “the cheerleader of death”. Macrophages gather near tumours and can build new blood vessels to nourish them and direct them to fresh parts of the body. “You may be a slim, toned paragon of wellness,” Ehrenreich writes, “and still, a macrophage within your body may decide to throw in its lot with an incipient tumour.”
Paradoxically, Natural Causes is about hope. Ehrenreich writes of a trial on patients with terminal diseases who have an all-consuming fear of death. They are given psilocybin (the active ingredient in magic mushrooms); they emerge having lost their fear. She explains that the drug suppresses the part of the brain concerned with the sense of self. The patients go through “ego dissolution”, “followed by a profound sense of unity with the universe”.A sense of perspective is regained.
They understand that long after their demise, the universe “seethes” with ongoing life, and they are at peace. If you are struggling with choices that weigh hope in potential medical advances that damage quality of life against non-treatment and the acceptance of a terminal diagnosis, this may not offer much comfort, but for me, as with so many of Ehrenreich’s books, Natural Causes is a much-needed tonic.
• Natural Causes: Life, Death and the Illusion of Control by Barbara Ehrenreich is published by Granta (£16.99). To order a copy for £14.44 go to guardianbookshop.com or call 0330 333 6846. Free UK p&p over £10, online orders only. Phone orders min p&p of £1.99
