Barbara Ehrenreich embarks on a wide-ranging critique of the presumptions embedded in our health-care system, our dietary and exercise regimens, our notions of aging, even our understanding of what the hell our bodies are doing, or not doing, at a cellular level to keep us alive.

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Book review

The very first entry in Barbara Ehrenreich’s bibliography of more than 20 nonfiction books, spanning five decades of distinguished writing largely on American culture, is an unlikely title: “The Uptake, Storage, and Intracellular Hydrolysis of Carbohydrates by Macrophages,” co-authored by Zanvil A. Cohn and published in 1969.

It is unlikely only in contrast to Ehrenreich’s later books, because the author, in 1969, had a freshly minted Ph.D. in cellular biology from the Rockefeller University, with special focus on the study of macrophages, long considered the immune system’s front-line defenders from malevolent invaders, among them cancer cells.

So when Ehrenreich first came upon research, starting 10 years ago, suggesting that not only does the immune system, led by macrophages, appear to allow cancer cells through the body’s checkpoints, but that it also facilitates the metastasizing of tumors in other parts of the body, “I could only think, This changes everything.”

“So it doesn’t take just one rogue cell to create a metastatic cancer,” she writes in her new book, “Natural Causes,” “it takes two — a cancer cell plus a normal, healthy and all-too-helpful macrophage.”

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Her keen interest in macrophages notwithstanding, Ehrenreich is hardly a disinterested messenger of this disturbing news. Her own cells have run amok themselves, the author having been diagnosed and treated for cancer nearly 20 years ago, an experience she insightfully details in a November 2001 Harper’s Magazine article “Welcome to Cancerland.”

She’s also 76 years old, pointing out that while there isn’t a stylistic rule, “it is usually sufficient when the deceased is in their seventies or older for the obituary writer to invoke ‘natural causes.’ It is sad when anyone dies, but no one can consider the death of a septuagenarian ‘tragic,’ and there will be no demand for an investigation.”

So with no small degree of self-interest pushing her forward, Ehrenreich embarks on a wide-ranging critique of the presumptions embedded in our health-care system, our dietary and exercise regimens, our notions of aging, even our understanding of what the hell our bodies are doing, or not doing, at a cellular level to keep us alive.

For starters, she parses the genuine science behind modern medicine versus the rituals performed by health professionals, as by shamans, to lend more authority to their interactions with patients.

For example, she cites the humiliation of a once-routine prebirth enema and lower-extremity shave, combined with the positioning of the mother on her back for delivery, all of which Ehrenreich says are physiologically unnecessary protocols that some doctors still practice.

“It was a perfect recipe for inducing women’s compliance with their accepted social role,” she writes, “rituals of humiliation followed by the fabulous ‘gift’ of a child.”

Then there’s the multibillion-dollar fitness and dietary industry, a slow-moving and easily discernible target that probably could be dinged from the comfort of a living-room recliner. However, Ehrenreich shrewdly observes that how and where we Americans exercise (or not), and what and where we eat and drink, all consign us, in a most pernicious way, to a social status that, wherever we land on the spectrum, none of us should carry. And she rightly skewers the questions we the living often ask of the dead: “Did she smoke? Drink excessively? Eat too much fat and not enough fiber? Can she, in other words, be blamed for her own death?”

But Ehrenreich is being glib when she writes, “Many of the people who got caught up in the health ‘craze’ of the late twentieth century — people who exercised, watched what they ate, abstained from smoking and heavy drinking — have nevertheless died.”

No one with any common sense or life experience should assume that regular exercise or a “healthful” diet will necessarily extend their life in this world. But the collateral vitality gained from such a regimen shouldn’t be so cavalierly dismissed.

In fact, it is in the face of a despair born of our body’s perplexing self-destruction, combined with our utter incapacity to exert all that much control over it, that Ehrenreich turns to a vitality of sorts. It is one thing to die in a dead world, she writes, but another thing altogether to die into the actual world, “which seethes with life, with agency other than our own, and at the very least, with endless possibility.”

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“Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer” by Barbara Ehrenreich; Twelve; 256 pp.; $27.

Barbara Ehrenreich will appear with KUOW’s Ross Reynolds at 7:30 p.m. Wednesday, May 2, at Seattle First Baptist Church, 1111 Harvard Ave., Seattle; $5 (townhallseattle.org).