Barbara Ehrenreich, at 77, is learning to just say no – no to the kind of intensive, intrusive medical tests that may tell her absolutely nothing, no to the books and the nostrums that say that you can live forever or make your body grow younger, not older. Once she realized she was old enough to die, Ehrenreich, the author of the new book “Natural Causes,” said she decided she would put up with no more “suffering, annoyance and boredom” in pursuit of a longer life. Instead, the woman who also wrote the groundbreaking book “Nickel and Dimed” chooses the foods she likes, the exercise that suffices, and the doctor visits that address only the pains she actually feels. Is American medicine — is American life — ready for this?
Do you remember the moment when you decided that, nuh-uh, no more?
It was a decision that took a long while. Bit by bit, I’d say, wait, why am I going to spend much of the afternoon in a waiting room of a doctor's complex to find out something I'm not sure I'm even going to act on in any way? And also I'm a serious person, and I have a background in science, so I would look up what the debate was among doctors themselves about the particular procedure that was being recommended for me. And if I found it controversial, I said, well, that's probably a reason not to do it.
It almost sounds un-American; we feel obligated and entitled to live as long as we can as well as we can, and that means taking advantage of every iteration of medical technology to tell us how we're doing on the inside.
Right, but if those things are not backed up by evidence, by medical science, then why are we doing it? So many things just in the last decade or so that were thought to be absolutely necessary have fallen into the category of questionable or not advised, like all the testing for prostate cancer, a lot of debate about the value of annual mammograms and so on, you go down the list.
And when I see all those debates, I say, the other thing I have to throw into this is my own subjective feeling that I don't want to spend my time this way.
Technology means that our bodies are no longer opaque as they were 50 and of course hundreds of years ago. How has that changed medicine, and our attitudes toward ourselves?
As the body became less opaque, with various scanning procedures particularly, doctors began to really feel impatient if they could not get inside, if they could not see through the skin. Everything had to be revealed. And I can understand that, out of curiosity, you might want to see through the skin, but I think we've gone too far with that, with the scanning and the screening.
We have this emphasis now on prevention, on what we can individually do to stave off suffering and death.
It’s true. The overall ideology for about 40 years now has been, you can prevent illness yourself. There was a realization in the 1970s that so many of the diseases that ultimately kill Americans are preventable just by simple changes in lifestyle.
You don't have to smoke cigarettes, you don't have to eat so much fatty meat. They began adding all these things so it became up to you to take care of your health. And if you required heroic intervention, well it was pretty much your own damn fault because you had failed yourself in some way. Maybe you had drunk too much alcohol, maybe you had not eaten enough fiber.
So people became increasingly obsessed with monitoring their own diet. Now we talk about curating what's on your plate, to be sure that you have all the proper nutrients -- at least those that are proper at that moment, because they change so much from week to week
But it was assumed that it was not the responsibility of the society to be more healthful, to limit pollution and so on. It was your responsibility to take care of yourself.
That taking of responsibility has, as often happens, moved to an extreme where, as you point out in the book, if someone dies, people perform a moral autopsy. “Well, did he smoke? Did he drink? Did she exercise enough?”
A recently widowed woman told me a couple weeks ago that when her husband died of cancer, all these people would come up to her and say, “Did he smoke?” And it infuriated her because the assumption was he must have done something wrong, otherwise he wouldn't have died.
Every death in that way becomes a kind of suicide. What did he or she do wrong? It's comforting to some people to hear that the person did something in their lives that could have brought this on themselves, but it's very stigmatizing to the person who's ill, and to the bereaved.
The gap between rich and poor that we see widening every year in this country does mirror the gap in the kind of healthcare, of medical care that rich and poor get. The concierge services from doctors that you write about in the book, gym memberships, organic food that is more expensive than non-organic food, junk food that is cheaper than healthy food. This is something that this country has not been able to resolve.
The differences in healthcare by social class and by race are striking. But it's not only that; there is greater tension, greater threat involved than being poor from day to day. It can be a very unhelpful level of threat. If you have the money, you'll be told that if you want a doctor to return your call, you’d better pay for concierge medicine, but it's bigger than that.
The rich are no longer interested in healthcare. That's that sort of low class. The rich are interested in wellness, which is this whole bifurcation developed between health and wellness. Health is just the absence of disease. Well, the rich want more than that. They want to be as perfect as they can be.
They want to be better than normal, and so they will go in for all sorts of — they're not treatments, but things that are supposed to make you well as opposed to healthy, like massage, Reiki, having hot rocks placed very artfully around your body — things like that.
They have no pretense of being evidence-based, but are just sort of things you can do to show that you can afford them.
One concept you really take to task in the book may be an oxymoron: healthy aging. I think everybody wants the same thing: a long, healthy life with a fairly quick, painless end. Healthy aging is selling that, isn’t it?
“Successful aging” is the term of art right now. My favorite book [on the topic] is one called “Younger Next Year.” It’s not enough to stay alive; you have to become better than you were in your youth, and it’s a very high standard to meet.
Unfortunately, one of the coauthors of that book died last year at a very young age, from cancer. It goes to show that you might die anyway, no matter how vigorously you exercise and meticulously you choose your diet and so on.
But what is healthy aging? Why is it an oxymoron?
Because aging does involve damage to the body. No way around that. Aging is a process — I hate to say it, but as I've experienced it's certainly true — it’s a process of increasing disability. Things get harder. Things go wrong. They don't get better again, as they might have done in your 30s or 40s.
And there's nothing to do except try to adapt to each new disability that comes along as best you can.
One very striking part of your book is what you called the Silicon Valley syndrome, not just extending the quality of life but living forever — what you called towering hubris. You write that Sergey Brin, the co-founder of Google, said he hopes one day to cure death?
If you are one of the richest and smartest people in the world, which you probably believe you are if you're a Silicon Valley mogul, death is an insult. Why would you let that happen to you? You’re too special to die.
They're funneling hundreds of millions of dollars, Silicon Valley money into research on life extension. And some of them are hoping to get to 220.
220 years old?
Yes. Some of them are hoping to go much higher than that. Some are hoping for immortality. I wish them luck.
We thought it was strange that people thought they would get themselves frozen and reanimated in 30 or 40 years!
Oh, that's so 20th century.
All this testing — when you go to the doctor and he checks your blood pressure or she does a blood panel on you — does this accomplish anything, to your way of thinking? Does it have a placebo effect? You said that the equipment might as well be made out of cardboard and it would have the same effect.
Yeah. The fallback for a lot of doctors has been to say that there must be a placebo effect that makes this all worthwhile, and so I thought, all right, if that's the case, could we make it a lot less expensive and just have pretend equipment? Pretend procedures? I was being silly, but not entirely. To say that to say it's all a placebo effect is to say that medicine is magic.
I think medicine is good. Our American model of “scientific medicine” is good for certain things, like dealing with trauma, wounds, injuries, infectious diseases most of the time. But it's not so good with a lot of the chronic diseases which are more likely to be the problem in old age.
It is astounding how little we do, unfortunately, in a concerted collective way to make life healthier for everybody.
For example, prenatal care and care right after giving birth for the mother — we don’t do a good job of that at all. The rate of maternal mortality, especially among black women in America, is going up. It’s going down just about everywhere else in the world.
There are obvious sorts of care that could be given without huge expense, and we're not doing a good job of getting it out there. We have to think about what things really seem to make a difference, and then how do we get them out to everybody?
The trend toward medical self-care by app has caught on tremendously. People monitor their blood pressure obsessively or their heart rates obsessively. Where is this taking us?
I’ve been thinking maybe I should do that! At least monitor the number of steps I take. If I may be a little philosophical about it, it’s part of a trend toward greater and greater kind of self-involvement, where your world ends just like an inch away from your skin.
That’s your little world, and you have to remain in charge of that and keeping watch over every everything you can measure in it. And it is your world. It doesn't include other people, it doesn’t include community, and that seems to me to leave a lot out.
Here we are in a culture where “old” is kind of a dirty word. We say “senior” to dodge that. And dying seems like an act of bad taste.
Oh, it's the worst, right? We need to think about how we think and talk about dying. It is going to happen. And that's something I felt when I was going around the country talking about this book — maybe my job is just telling people that, yes, we are going to die.
How do we make our lives as good as we can in the time we have left to ourselves to do it? It's not the end of the whole world when I die. It's just the end of me, Barbara Ehrenreich.
But the world that I have known and loved continues, and so that makes my death kind of incidental.
Maybe that's what bothers people most about dying, that the world will still continue, that the blackbird will sing and the earthworm will creep — and they'll be gone.
That's an interesting angle to take. But I feel the opposite way. I have lived long enough to see a lot of the beauty of the world; it thrills me. It thrills me that it will continue. I have worked all my life for certain things — social justicey types of things, better healthcare for people, stop the war, whatever. And I know that other people will pick up that work. I know I am not essential to it.
And that's great, to feel that I have been part of a human movement or movements that started long before me and will continue long after me.
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