A Dose Of Reality

Abstract

Book Review Health AffairsVol. 37, No. 11: Patient Safety A Dose Of RealityRick Mathis AffiliationsRick Mathis ([email protected]) teaches health policy at the University of Tennessee at Chattanooga and is a health researcher in information delivery at BlueCross BlueShield of Tennessee, also in Chattanooga.PUBLISHED:November 2018Free Accesshttps://doi.org/10.1377/hlthaff.2018.1098AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSDietary habitsCancerGovernment programs and policiesThere is a certain sense of regret that those of us over fifty may feel when reading the popular literature on healthy living. Much of this genre advances lifestyle changes purporting not only to make us healthier but to extend life as well. But what about all of the years we’ve spent not following these recommendations? Are we not going to live healthily into our eighties and beyond because we failed to adhere to a certain diet or engage in mindfulness practices when we were younger? Barbara Ehrenreich’s latest book is a good if somewhat sobering antidote to this kind of despair. Ehrenreich, who has a PhD in cellular immunology and has written several books related to health care and medicine, questions our tendency to become obsessed with lifestyle fads in hopes of cheating illness and death.In Natural Causes, Ehrenreich effectively lampoons the modern tendency to see death as more of a choice than a combination of unfortunate circumstances and natural processes. We subject anyone who dies at anything less than extreme old age to a kind of “bio-moral autopsy,” asking whether the person smoked or drank excessively or ate too much fat. We wonder, for example, whether David Bowie would have lived beyond what once was considered the respectable age of sixty-nine if he had never smoked. Instead of seeing death as the natural end of life, we see it, in a sense, as suicide.Undergirding Ehrenreich’s argument against this perspective is the fact that increasing infirmity is part of the aging process. She also notes the randomness of biological processes in the development of such conditions as cancer. Further, cells once thought to improve healing are now seen as capable of turning on their hosts and exacerbating illness. Our bodies are best characterized as battlegrounds of conflict rather than sites of harmonious processes capable of being trained toward perfect health. We may influence this conflict through personal habits and medical technologies so that immune cells act more responsibly. However, we cannot completely control the conflict, and we certainly cannot forestall its inevitable outcome of death. Moreover, efforts to prolong life often result in a poor quality of life toward the end. “The price we’re paying for extended life spans is a high rate of late-life disability,” writes a New York Times columnist whom Ehrenreich quotes. Or, as the late novelist Philip Roth wrote, “old age isn’t a battle; old age is a massacre.”Although this attempt to inject a dose of reality into popular thinking about health is certainly laudable, Ehrenreich at times overstates her case. She observes, for example, that most of the medical screenings she has been advised to undertake lack evidence. As an example, she cites the recommendation that women in their forties and fifties get a mammogram annually. Yet she doesn’t provide enough evidence to make the case convincingly not only against annual mammograms but against all screenings. Since she is a breast cancer survivor, one wonders how she would assess her own diagnosis and treatment. She also mentions some notable people who died prematurely in spite of slavish devotions to diet and exercise: Jim Fixx, author of The Complete Book of Running, died of a heart attack at age fifty-two, and Steven Jobs, a strict vegan, died of pancreatic cancer at age fifty-six. As intriguing as such observations may be, they are individual reports and hardly rate as scientific evidence.That being said, the very readable Natural Causes serves as a knock on the head for those of us who are easily swayed by the latest lifestyle fad that promises to extend life and prevent chronic disease. It can also help assuage concerns. While I was reading this book, a female friend who is my age expressed concern about a diagnosis of osteopenia, or mild bone thinning, and wondered what she could have done to prevent this. I was able to cite Ehrenreich’s comment that osteopenia is not so much a disease as a normal feature of aging. In health and health policy, as in life in general, it helps to remember not only that we age, but also how we age—and adjust our expectations accordingly. Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 5 November 2018 Information© 2018 Project HOPE—The People-to-People Health Foundation, Inc.PDF download