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 		 [Medicine has grown so powerful and so profitable procedures go
unquestioned. Many tests detect something worthy of follow-up --
procedures sometimes dubious, all to the point of extending life
without regard to its quality. Stealing a march on every medical
vulnerability as you age can boomerang. ] [https://portside.org/] 

 PORTSIDE CULTURE 

 THE IMPATIENT PATIENT  
[https://portside.org/2018-04-12/impatient-patient] 

 

 Scott McLemee 
 April 6, 2018
Inside Higher Education
[https://www.insidehighered.com/views/2018/04/06/review-barbara-ehrenreich-%E2%80%98natural-causes-epidemic-wellness-certainty-dying-and]


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 _ Medicine has grown so powerful and so profitable procedures go
unquestioned. Many tests detect something worthy of follow-up --
procedures sometimes dubious, all to the point of extending life
without regard to its quality. Stealing a march on every medical
vulnerability as you age can boomerang. _ 

 , 

 

 

BARBARA EHRENREICH,  NATURAL CAUSES: AN EPIDEMIC OF WELLNESS, THE
CERTAINTY OF DYING, AND KILLING OURSELVES TO LIVE LONGER. 

(HACHETTE BOOK GROUP, APRIL 2018, HARDBACK, $17.95) 

ISBN: 978-1-4555-3591-0

IN THE EVENT THAT OTHER DEVELOPMENTS ON THE WORLD STAGE HAVEN’T
LEFT YOU IN A STATE OF QUIVERING ANXIETY, THE CENTERS FOR DISEASE
CONTROL AND PREVENTION PUT OUT A REPORT THIS WEEK THAT OUGHT TO DO THE
TRICK. THE CDC STATEMENT
[https://www.cdc.gov/mmwr/volumes/67/wr/mm6713e1.htm] BEARS THE TITLE
“CONTAINMENT OF NOVEL MULTIDRUG-RESISTANT ORGANISMS AND RESISTANCE
MECHANISMS -- UNITED STATES, 2006-2017,” WHICH SOON TRANSLATED INTO
HEADLINES SUCH AS “‘NIGHTMARE BACTERIA’ ARE TRYING TO SPREAD IN
THE U.S., CDC SAYS.”

WE’VE BEEN HEARING ABOUT THE RISE OF ANTIBIOTIC-RESISTANT (AR)
STRAINS OF DISEASES FOR DECADES. THEY NOW KILL MORE THAN 23,000
AMERICANS PER YEAR. MORE TROUBLING THAN THAT IS THE DISCOVERY -- FROM
A NEW PROGRAM OF SCREENINGS -- THAT 11 PERCENT OF HEALTH-CARE WORKERS
IN CONTACT WITH PATIENTS WITH AR INFECTIONS WERE “COLONIZED” BY
THE STRAIN IN QUESTION. THAT IS, THEY WERE CARRYING AROUND THE HIGHLY
COMMUNICABLE AND HARD-TO-TREAT GERMS WITHOUT THEMSELVES EXHIBITING ANY
SYMPTOMS. AND AR-ENABLING GENETIC MATERIAL CAN BE TRANSFERRED FROM ONE
DISEASE TO ANOTHER; DISEASES PREVIOUSLY TREATABLE WITH ANTIBIOTICS CAN
MUTATE INTO TOUGHER FORM.

SUMMING UP ITS FINDINGS FOR THE GENERAL PUBLIC, CDC UNDERSCORES THE
EFFICACY OF EARLY DETECTION AND CONTAINMENT OF AR PATHOGENS. BUT
ALMOST TWO YEARS’ WARNING THAT IT WAS COMING SEEMS NOT TO HAVE
SLOWED DOWN A BACTERIUM REPORTED IN ENGLAND LAST MONTH UNDER THE
HORRIFYING MONIKER “SUPER-GONORRHEA
[https://www.inverse.com/article/42973-super-gonorrhea-antibiotics-drug-resistant-organisms].”

BLIND CONFIDENCE IN THE POWERS OF EARLY DETECTION AND PREVENTATIVE
MEDICINE IS THE MAIN TARGET OF BARBARA EHRENREICH’S NATURAL CAUSES:
AN EPIDEMIC OF WELLNESS, THE CERTAINTY OF DYING, AND KILLING OURSELVES
TO LIVE LONGER (TWELVE
[https://www.twelvebooks.com/titles/barbara-ehrenreich/natural-causes/9781455535910/]).
IN SOME WAYS, IT IS A BOOK-LENGTH SEQUEL TO “WELCOME TO CANCERLAND
[http://pinkribbonblues.org/wp-content/uploads/2010/08/Ehrenreich-2001-WelcomeToCancerland-Harpers.pdf],”
HER UNFORGETTABLE ESSAY FROM 2001. THERE, IN RECOUNTING HER DIAGNOSIS
AND TREATMENT FOR BREAST CANCER, EHRENREICH’S INSTINCTS AS A
MUCKRAKER KEPT HER IN A STANDOFF WITH WHAT SHE CALLED “CANCER
CULTURE”: WHILE THE MEDICAL PROTOCOL LEFT HER DEPLETED AND NAUSEOUS,
THE NEW AGE-TINGED DEMANDS FOR POSITIVE THINKING FELT INSIPID AND
INFANTILIZING.

“WHAT SUSTAINED ME THROUGH THE ‘TREATMENTS,’” SHE WROTE, “IS
A PURIFYING RAGE, A RESOLVE, FRAMED IN THE SLEEPLESS NIGHTS OF
CHEMOTHERAPY, TO SEE THE LAST POLLUTER, ALONG WITH, SAY, THE LAST SMUG
HEALTH-INSURANCE OPERATIVE, STRANGLED WITH THE LAST PINK RIBBON … I
WILL NOT GO INTO THAT LAST GOOD NIGHT WITH A TEDDY BEAR TUCKED UNDER
MY ARM.”

AT THAT POINT, EHRENREICH WAS 60 YEARS OLD. NATURAL CAUSES IS THE WORK
OF A WRITER WHO CAN SEE HER 80S APPROACHING AT NOT TOO GREAT A
DISTANCE, AND WHO HAS COME TO CERTAIN CONCLUSIONS. SHE IS, SHE SAYS,
“OLD ENOUGH TO DIE,” ALTHOUGH IN NO GREAT HURRY TO DO SO, AND
CONSIDERS IT “AN ACHIEVEMENT, NOT A DEFEAT, AND THE FREEDOM IT
BRINGS IS WORTH CELEBRATING.” SHE DECLINES “TO INCUR ANY MORE
SUFFERING, ANNOYANCE OR BOREDOM IN THE PURSUIT OF A LONGER LIFE,”
SHE SAYS. “I EAT WELL, MEANING I CHOOSE FOODS THAT TASTE GOOD AND
THAT WILL STAVE OFF HUNGER FOR AS LONG AS POSSIBLE, LIKE PROTEIN,
FIBER AND FATS. I EXERCISE -- NOT BECAUSE IT WILL MAKE ME LIVE LONGER
BUT BECAUSE IT FEELS GOOD WHEN I DO. AS FOR MEDICAL CARE: I WILL SEEK
HELP FOR AN URGENT PROBLEM, BUT I AM NO LONGER INTERESTED IN LOOKING
FOR PROBLEMS THAT REMAIN UNDETECTABLE TO ME.”

SUCH A DECISION HAS NOT BEEN POSSIBLE, LET ALONE NECESSARY, FOR VERY
MANY PEOPLE THROUGHOUT MOST OF HISTORY. LIFE EXPECTANCY IN THE UNITED
STATES OVER THE PAST 150 YEARS HAS NEARLY DOUBLED, AND IT CONTINUES TO
INCREASE. THE ALL-TOO-AMERICAN DEFAULT ATTITUDE HOLDS THAT MORE IS
BETTER, PRETTY MUCH BY DEFINITION, BUT EXTENDING THE LENGTH OF LIFE
WITHOUT REGARD TO ITS QUALITY SOUNDS LIKE A RECIPE FOR HELL ON EARTH.
EHRENREICH'S CONCERN IS THAT MEDICINE HAS GROWN BOTH SO POWERFUL AND
SO PROFITABLE THAT MANY PROCEDURES HAVE BECOME PRACTICALLY AUTOMATIC
AND UNQUESTIONABLE. IN PARTICULAR, PATIENTS HAVE GROWN ACCUSTOMED TO
UNDERGOING "TESTS AND EXAMINATIONS THAT, IN SUFFICIENT QUANTITY, ARE
BOUND TO DETECT SOMETHING WRONG OR AT LEAST WORTHY OF FOLLOW-UP" --
PROCEDURES THE RELIABILITY OF WHICH ARE SOMETIMES DUBIOUS, WITH
SERIOUS CONSEQUENCES FROM FALSE POSITIVES.

AN EXAMPLE IS THE EXTREME RATE OF OVERDIAGNOSIS FOR THYROID CANCER: UP
70 TO 80 PERCENT OF THE SURGERY FOR IT PERFORMED ON WOMEN IN THE
U.S., FRANCE AND ITALY IN THE '00S IS NOW DETERMINED TO HAVE BEEN
UNNECESSARY, LEAVING PATIENTS WITH A LIFELONG DEPENDENCE ON THYROID
HORMONES. JUST AS EXCESSIVE RELIANCE ON ANTIBIOTICS GAVE RISE TO
"NIGHTMARE GERMS" THEY ARE INEFFECTIVE TO TREAT, THE EFFORT TO STEAL A
MARCH ON EVERY MEDICAL VULNERABILITY AS YOU AGE CAN BOOMERANG.

BUT OVERTESTING IS, BY EHRENREICH'S ACCOUNT, ULTIMATELY MORE A SYMPTOM
THAN THE REAL PROBLEM. MOVING FROM SOCIAL CRITICISM TO SCIENTIFIC
POPULARIZATION AND CONTEMPLATIVE DIGRESSIONS ON HOW WE SITUATE
OURSELVES IN THE NATURAL ORDER, SHE FINDS THAT BOTH MEDICAL SCIENCE
AND THE SELF-HELP CULTURE ARE PRONE TO EXAGGERATING THE POSSIBILITIES
FOR HUMAN CONTROL OVER LIFE, HEALTH AND LONG-TERM SUCCESS IN THE
PURSUIT OF HAPPINESS. SHE PUTS IT THIS WAY:

OUR PREDECESSORS PROCEEDED FROM AN ASSUMPTION OF HUMAN HELPLESSNESS IN
THE FACE OF A JUDGMENTAL AND ALL-POWERFUL GOD WHO COULD SWOOP DOWN AND
KILL TENS OF THOUSANDS AT WILL, WHILE TODAY’S ASSUMPTION IS ONE OF
ALMOST UNLIMITED HUMAN POWER. WE CAN, OR THINK WE CAN, UNDERSTAND THE
CAUSES OF DISEASE IN CELLULAR AND CHEMICAL TERMS, SO WE SHOULD BE ABLE
TO AVOID IT BY FOLLOWING THE RULES LAID DOWN BY MEDICAL SCIENCE:
AVOIDING TOBACCO, EXERCISING, UNDERGOING ROUTINE MEDICAL SCREENING AND
EATING ONLY FOODS CURRENTLY CONSIDERED HEALTHY. ANYONE WHO FAILS TO DO
SO IS INVITING AN EARLY DEATH. OR TO PUT IT ANOTHER WAY, EVERY DEATH
CAN NOW BE UNDERSTOOD AS SUICIDE.

WHICH IS RIDICULOUS, OF COURSE, AS IS THE POINT. IN A SECTION OF THE
BOOK THAT READS AS IF THE AUTHOR IS PLANTING DYNAMITE UNDER EVERY
"HOLISTIC" INSTITUTION EVER TO PROMOTE WELLNESS, SHE CHALLENGES THE
POPULAR UNDERSTANDING OF THE BODY AS "A SMOOTH-RUNNING MACHINE IN
WHICH EACH PART OBEDIENTLY PERFORMS ITS TASKS FOR THE BENEFIT OF THE
COMMON GOOD." THERE IS EVIDENCE TO THE CONTRARY IN THE BEHAVIOR OF THE
IMMUNE SYSTEM, AND WE MIGHT DO BETTER TO PICTURE A NORM OF "CONFLICT
WITHIN THE BODY … CARRIED ON BY THE BODY’S OWN CELLS AS THEY
COMPETE FOR SPACE AND FOOD AND OXYGEN. WE MAY INFLUENCE THE OUTCOME OF
THESE CONFLICTS-- THROUGH OUR PERSONAL HABITS AND PERHAPS EVENTUALLY
THROUGH MEDICAL TECHNOLOGIES THAT WILL PERSUADE IMMUNE CELLS TO ACT IN
MORE RESPONSIBLE WAYS -- BUT WE CANNOT CONTROL IT."

CONTROL IS A SHORT-TERM PROPOSITION, AT BEST, WHILE OUR LONG-RANGE
CHANCES WERE BEST PUT BY WHOEVER DESIGNED THAT T-SHIRTS THAT READ
"EXERCISE. EAT RIGHT. DIE ANYWAY."

BOOK AUTHOR BARBARA EHRENREICH
[https://www.hachettebookgroup.com/contributor/barbara-ehrenreich/]
HAS WRITTEN MORE THAN A DOZEN BOOKS, INCLUDING THE NEW YORK TIMES
BESTSELLER NICKEL AND DIMED. WINNER OF THE 2018 ERASMUS PRIZE FOR HER
WORK AS AN INVESTIGATIVE JOURNALIST, SHE HAS A PHD IN CELLULAR
IMMUNOLOGY FROM ROCKEFELLER UNIVERSITY AND WRITES FREQUENTLY ABOUT
HEALTH CARE AND MEDICAL SCIENCE, AMONG MANY OTHER SUBJECTS. SHE LIVES
IN VIRGINIA.

ESSAYIST  SCOTT MCLEMEE
[https://www.insidehighered.com/users/scott-mclemee] IS THE
INTELLECTUAL AFFAIRS COLUMNIST FOR INSIDE HIGHER ED. IN 2008, HE BEGAN
A THREE-YEAR TERM ON THE BOARD OF DIRECTORS OF THE NATIONAL BOOK
CRITICS CIRCLE. FROM 1995 UNTIL 2001, HE WAS CONTRIBUTING EDITOR FOR
LINGUA FRANCA. BETWEEN 2001 AND 2005, HE COVERED SCHOLARSHIP IN THE
HUMANITIES AS SENIOR WRITER AT THE CHRONICLE OF HIGHER EDUCATION. IN
2005, HE HELPED START THE ONLINE NEWS JOURNAL INSIDE HIGHER ED, WHERE
HE SERVES AS ESSAYIST AT LARGE, WRITING A WEEKLY COLUMN CALLED
INTELLECTUAL AFFAIRS. HIS REVIEWS, ESSAYS, AND INTERVIEWS HAVE
APPEARED IN THE NEW YORK TIMES, THE WASHINGTON POST, THE BOSTON GLOBE,
THE NATION, NEWSDAY, BOOKFORUM, THE COMMON REVIEW, AND NUMEROUS OTHER
PUBLICATIONS. IN 2004, HE RECEIVED THE NONA BALAKIAN CITATION FOR
EXCELLENCE IN REVIEWING FROM THE NATIONAL BOOK CRITICS CIRCLE. HE HAS
GIVEN PAPERS OR BEEN AN INVITED SPEAKER AT MEETINGS OF THE AMERICAN
POLITICAL SCIENCE ASSOCIATION, THE CULTURAL STUDIES ASSOCIATION, THE
MODERN LANGUAGE ASSOCIATION, AND THE ORGANIZATION OF AMERICAN
HISTORIANS.

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