Barbara Ehrenreich’s Radical Critique of Wellness and Self-improvement
May 24, 2018 3:23 PM Subscribe
At first glance, her new book, Natural Causes, is a polemic against wellness culture and the institutions that sustain it. It opens with her decision to reject a series of medical interventions.
Once associated with play, exercise is now closer to a form of labor: measured, timed, and financially incentivized by employers and insurers. Like any kind of alienated labor, it assumes and intensifies the division between mind and body—indeed, it involves a kind of violence by the mind against the body.
Once associated with play, exercise is now closer to a form of labor: measured, timed, and financially incentivized by employers and insurers. Like any kind of alienated labor, it assumes and intensifies the division between mind and body—indeed, it involves a kind of violence by the mind against the body.
“You can think of death bitterly or with resignation ... and take every possible measure to postpone it,” she offers at the beginning of the book. “Or, more realistically, you can think of life as an interruption of an eternity of personal nonexistence, and seize it as a brief opportunity to observe and interact with the living, ever-surprising world around us.”My mother said more than once that she didn't want to die with a bunch of tubes stuck into her. And she died quietly in her bed, at home... until I found her, and panicked, and called 9-1-1, and they got her heart going for a few minutes at the hospital by sticking a bunch of tubes into her.
I can only hope she never felt it. I feel like I betrayed her in that moment.
I'm sorry, Mom.
posted by clawsoon at 4:35 PM on May 24, 2018 [127 favorites]
Clawsoon, it's very, very hard to loose one's mother, and we are so trained to save people...
But yes, facing death is something this culture really needs to do better.
posted by allthinky at 4:36 PM on May 24, 2018 [14 favorites]
But yes, facing death is something this culture really needs to do better.
posted by allthinky at 4:36 PM on May 24, 2018 [14 favorites]
The illusion of control preys on the lucky.
The unlucky have no such confusion.
posted by Construction Concern at 4:42 PM on May 24, 2018 [55 favorites]
The unlucky have no such confusion.
posted by Construction Concern at 4:42 PM on May 24, 2018 [55 favorites]
exercise is now closer to a form of labor: measured, timed, and financially incentivized by employers and insurers.
My husband's employer has this stupid (and more and more common) thing with their insurance, where you need to talk on the phone with a "wellness coach" a few times a year. Their job is to tell you things like "eat less." and "get more exercise."
This last time, the wellness coach did, in fact tell my (six foot six, very fit) husband that he should "get more exercise" based on his BMI.
My husband works in a production-oriented warehouse. He walks an average of 16 miles a day at work, and spends the day moving 60 lb boxes around. But if he starts going to the gym, he'll get $50 a year off his insurance.
posted by anastasiav at 4:45 PM on May 24, 2018 [62 favorites]
My husband's employer has this stupid (and more and more common) thing with their insurance, where you need to talk on the phone with a "wellness coach" a few times a year. Their job is to tell you things like "eat less." and "get more exercise."
This last time, the wellness coach did, in fact tell my (six foot six, very fit) husband that he should "get more exercise" based on his BMI.
My husband works in a production-oriented warehouse. He walks an average of 16 miles a day at work, and spends the day moving 60 lb boxes around. But if he starts going to the gym, he'll get $50 a year off his insurance.
posted by anastasiav at 4:45 PM on May 24, 2018 [62 favorites]
Note to self: do not annoy anastasiav.
posted by y2karl at 4:48 PM on May 24, 2018 [9 favorites]
posted by y2karl at 4:48 PM on May 24, 2018 [9 favorites]
And, accustomed to the present system, many patients now worry that anything less than constant testing and maximal intervention would leave them at risk: “An internist in Burlington, North Carolina, reports that when he told a 72-year-old patient that she did not need many of the tests she was expecting in her annual physical, she wrote a letter to the local paper about him as an example of ‘socialized medicine.’ ”The old lady is right, you know. The job of capitalist medicine is to make you buy more medicine, to stoke your anxieties with a flood of advertising so that production can be increased. It's like selling Coca-Cola: The more, the better.
This, too, I suspect, is part of what makes American healthcare so expensive overall.
posted by clawsoon at 4:51 PM on May 24, 2018 [20 favorites]
This looks great. I enjoyed the article and am ordering the book now. It’s important to find a primary care doctor who takes a minimal intervention approach. See a family practice doc who is an employee of a 100% hospital owned practice. They don’t have personal income incentives to overdo. And the hospitals are instituting evidence based medicine compliance incentive instead, often prioritizing a preventive actions. It seems counterintuitive perhaps but research say they do better overall.
While I’m her, also, avoid orthopedic surgeons. Ask to see physical therapists instead. And be aware that any spine surgery you’re considering is unlikely to fix your pain. Finally, if you’re 70, go for the do not resuscitate.
posted by putzface_dickman at 4:52 PM on May 24, 2018 [4 favorites]
While I’m her, also, avoid orthopedic surgeons. Ask to see physical therapists instead. And be aware that any spine surgery you’re considering is unlikely to fix your pain. Finally, if you’re 70, go for the do not resuscitate.
posted by putzface_dickman at 4:52 PM on May 24, 2018 [4 favorites]
Enjoyed her discussion of the topic on C-Span.
posted by Mr.Me at 5:17 PM on May 24, 2018 [1 favorite]
posted by Mr.Me at 5:17 PM on May 24, 2018 [1 favorite]
My husband works in a production-oriented warehouse. He walks an average of 16 miles a day at work, and spends the day moving 60 lb boxes around. But if he starts going to the gym, he'll get $50 a year off his insurance.
Pretty sure the gym costs more than $50 a year
posted by Merus at 5:21 PM on May 24, 2018 [22 favorites]
Pretty sure the gym costs more than $50 a year
posted by Merus at 5:21 PM on May 24, 2018 [22 favorites]
This was a very good piece for me to read right now and I should probably check out the book.
My father died of cancer a couple of months back. We were not on good terms, for basically all of my adult life, to say the least. But it was important to me that I tend to him on his deathbed so I went out to NM what turned out to be a month before he died. I did my best to provide relief.
I don't agree with much of how my parents arranged their (and my) life, but ironically I have to say that they got death right. They had decided that it was important that he die at home, in his bed. And they were able to achieve that, fortunately. The hospice nurse came for about an hour twice a week and then daily towards the end, and an aide daily to help him bathe. I liked the hospice nurse. She was very good at combining directness with compassion - I was amazed at her poise when he asked her, in one of his last lucid moments, "am I going to die?", and she just gently said "well, your body's starting some transitions that are a part of that process and we're going to do our best to make you comfortable." She was also very pragmatic - when my father started getting bedsores and needed a pad for the bed, after calling the office to determine they didn't distribute pads except as part of an entire hospital bed - which was neither desired nor necessary - she proffered, "You know you could just get the bed and take the pad off of it," which in fact ended up happening.
The DNR was pinned to the fridge with a magnet. It allowed only for liquid nutrition, and that only "for 2-3 days to see if condition improves."
But the great irony, and the reason I connected this to this particular piece, is that it seems very much the case that my father's otherwise good health ("Other than that, Mrs Lincoln..." - or in the words of the nurse, "Except for the dumb cancer...") prolonged his suffering. He became bedridden about 2 weeks after I arrived, and basically gave up at that point with a few scattered episodes of some activity. He stopped taking food, and not much later liquids. But he had especially in the last few years been increasingly physically active, particularly walking. So his cardiovascular system kept him alive a full 17 days further while his body melted before our eyes. Even unto the end: 3 days before he died his unassisted O2Sat was 98%. And all the time he was on a shit ton of morphine and oxycodone and gabapentin and weed and also clearly still in rarely-pausing pain. Would he have spent less time in that state if he hadn't decided to lose weight? Who can say.
(clawsoon, it's not a situation one can practice or honestly prepare for, we get one shot and we do the best we can in the moment given which moment it is and that's it, all of us, I hope for you that you are able to not buy into the guilt you've expressed)
posted by PMdixon at 5:39 PM on May 24, 2018 [41 favorites]
My father died of cancer a couple of months back. We were not on good terms, for basically all of my adult life, to say the least. But it was important to me that I tend to him on his deathbed so I went out to NM what turned out to be a month before he died. I did my best to provide relief.
I don't agree with much of how my parents arranged their (and my) life, but ironically I have to say that they got death right. They had decided that it was important that he die at home, in his bed. And they were able to achieve that, fortunately. The hospice nurse came for about an hour twice a week and then daily towards the end, and an aide daily to help him bathe. I liked the hospice nurse. She was very good at combining directness with compassion - I was amazed at her poise when he asked her, in one of his last lucid moments, "am I going to die?", and she just gently said "well, your body's starting some transitions that are a part of that process and we're going to do our best to make you comfortable." She was also very pragmatic - when my father started getting bedsores and needed a pad for the bed, after calling the office to determine they didn't distribute pads except as part of an entire hospital bed - which was neither desired nor necessary - she proffered, "You know you could just get the bed and take the pad off of it," which in fact ended up happening.
The DNR was pinned to the fridge with a magnet. It allowed only for liquid nutrition, and that only "for 2-3 days to see if condition improves."
But the great irony, and the reason I connected this to this particular piece, is that it seems very much the case that my father's otherwise good health ("Other than that, Mrs Lincoln..." - or in the words of the nurse, "Except for the dumb cancer...") prolonged his suffering. He became bedridden about 2 weeks after I arrived, and basically gave up at that point with a few scattered episodes of some activity. He stopped taking food, and not much later liquids. But he had especially in the last few years been increasingly physically active, particularly walking. So his cardiovascular system kept him alive a full 17 days further while his body melted before our eyes. Even unto the end: 3 days before he died his unassisted O2Sat was 98%. And all the time he was on a shit ton of morphine and oxycodone and gabapentin and weed and also clearly still in rarely-pausing pain. Would he have spent less time in that state if he hadn't decided to lose weight? Who can say.
(clawsoon, it's not a situation one can practice or honestly prepare for, we get one shot and we do the best we can in the moment given which moment it is and that's it, all of us, I hope for you that you are able to not buy into the guilt you've expressed)
posted by PMdixon at 5:39 PM on May 24, 2018 [41 favorites]
I love Barbara Ehrenreich. This book is especially timely for me -- my research focuses on motivating people to exercise (so many health benefits of exercise!) but I'm simultaneously concerned about the social class markers of exercise. Example: I am of Indian origin, my grandfather did yoga as a spiritual practice every morning, I recommend yoga to my patients (mostly Veterans in their 70s) because of the flexibility benefits -- and yet the culture of yoga is, well, skinny white chicks in leggings. I feel alienated from my birthright; my patients are too polite to tell me how they really feel, but not a one of them does yoga. Why would they, if they cannot see themselves reflected in the ads for local yoga studios.
I'm also concerned about the capitalist impulses that underlie all this: if gamification is the next big thing in exercise, how do we reach the folks who can't afford Fitbits or Bowflex Home Gyms, or are (because of historical tension with authority, or because they are really prescient) suspicious of a central database tracking your every movement.
Which is to say: this book is going on my list.
posted by basalganglia at 6:22 PM on May 24, 2018 [37 favorites]
I'm also concerned about the capitalist impulses that underlie all this: if gamification is the next big thing in exercise, how do we reach the folks who can't afford Fitbits or Bowflex Home Gyms, or are (because of historical tension with authority, or because they are really prescient) suspicious of a central database tracking your every movement.
Which is to say: this book is going on my list.
posted by basalganglia at 6:22 PM on May 24, 2018 [37 favorites]
I recommend yoga to my patients (mostly Veterans in their 70s) because of the flexibility benefits -- and yet the culture of yoga is, well, skinny white chicks in leggings.
Get them to check out Everybody Yoga
posted by thelonius at 6:40 PM on May 24, 2018 [5 favorites]
Get them to check out Everybody Yoga
posted by thelonius at 6:40 PM on May 24, 2018 [5 favorites]
One of the best parts about life is the fun you can have taking risks. Drive that car. Walk across a busy intersection. Go to a performance you haven't seen a review for. Smoke another cig. Run electricity through a carbon-coated wool fiber. Double the voltage.
Ride that ferris wheel. Ski down a snowy slope lined with trees. Swim out from the shore, knowing you have to swim back. Swim out and then drop down a wall of water. Walk (or ride your farting ATV) down a wilderness trail you've never been on before. Walk a trail not on your map. Walk a trail not on -any- map.
Start writing a book. Keep writing after you realize what you've gotten yourself into. Take a pill without being sure how many micrograms the dose is. Step out of the sauna and dive into the lake, avoiding the ice chunks. (Read John Updike? meh.)
Life is full of choices. *Every damn choice* has risk built in. Good thing for the human race we accept those risks. Anyone who suggests otherwise is a friend of death. So, go die, and effing leave me alone.
posted by Twang at 6:42 PM on May 24, 2018 [7 favorites]
Ride that ferris wheel. Ski down a snowy slope lined with trees. Swim out from the shore, knowing you have to swim back. Swim out and then drop down a wall of water. Walk (or ride your farting ATV) down a wilderness trail you've never been on before. Walk a trail not on your map. Walk a trail not on -any- map.
Start writing a book. Keep writing after you realize what you've gotten yourself into. Take a pill without being sure how many micrograms the dose is. Step out of the sauna and dive into the lake, avoiding the ice chunks. (Read John Updike? meh.)
Life is full of choices. *Every damn choice* has risk built in. Good thing for the human race we accept those risks. Anyone who suggests otherwise is a friend of death. So, go die, and effing leave me alone.
posted by Twang at 6:42 PM on May 24, 2018 [7 favorites]
My friend, who later died from Hodgkin's Lymphoma, used to tell a joke:
- Why do they nail coffins shut?
- To keep the oncologists out.
posted by drnick at 7:07 PM on May 24, 2018 [61 favorites]
- Why do they nail coffins shut?
- To keep the oncologists out.
posted by drnick at 7:07 PM on May 24, 2018 [61 favorites]
drnick, as someone who last year lost their dad after a nineteen-year series of cancers, during which the will-he-won't-he of survival and inexplicable news from oncologists nearly overwhelmed any other part of our relationship with him -- that joke brought a guffaw of dark recognition.
posted by gusandrews at 8:48 PM on May 24, 2018 [1 favorite]
posted by gusandrews at 8:48 PM on May 24, 2018 [1 favorite]
This book looks great. This is one of my favorite subjects. I don’t have much to add right now except that I read a similar book for a class a couple years ago that other people might be interested in: Drugs for Life: How Pharmaceutical Companies Define Our Health
(Despite the title, it is very much not some bullshit anti-vax stuff.)
It is very interesting to see how our ideas of health are defined, and to question the concepts of risk and responsibility in today’s society. Medicine and culture go very much hand in hand. Ehrenreich’s book sounds like a great addition to the subject.
posted by shapes that haunt the dusk at 8:57 PM on May 24, 2018 [1 favorite]
(Despite the title, it is very much not some bullshit anti-vax stuff.)
It is very interesting to see how our ideas of health are defined, and to question the concepts of risk and responsibility in today’s society. Medicine and culture go very much hand in hand. Ehrenreich’s book sounds like a great addition to the subject.
posted by shapes that haunt the dusk at 8:57 PM on May 24, 2018 [1 favorite]
I don't have heroes. But if I did then Barbara Ehrenreich would one of the first.
Note to self: do not annoy anastasiav.
Nor her (six foot six, very fit) husband.
Walk (or ride your farting ATV) down a wilderness trail you've never been on before. Walk a trail not on your map. Walk a trail not on -any- map.
Or just make your own trail.
When I was young and foolish and hence invulnerable, decades before mobile phones and emergency beacons were a thing, I used to ride my trail motorbike alone out along the highway, waaaaay out of my small home town, into some of the most remote, unpopulated, and unforgiving country on earth.
Then I would just turn off the sealed road at random and proceed through the often thick and rough natural bushland in whatever direction I felt like for hours. My only limits were water and fuel, and my own grossly underdeveloped teenage sense of self-preservation. Didn't even take a weapon of any kind into country with wild pigs and buffalo roaming free, and endless venomous critters (being Australia).
Never told anybody what I was doing, let alone where I was going.
It was as risky as hell, and completely defied all basic common sense. The sort of utter madness that should get you a custodial sentence and ten lashes if you recommended it to anybody else. But my luck and survival instinct held enough to never have any serious problems.
It was also some of my most formative experiences and precious memories, and I can honestly say that I have never regretted doing it.
Taking risks can kill you, brutally, and in a f'ing heartbeat. But they can make you as well. In fact, that is the only way to make yourself.
You must take risks to even merely survive, let alone move forward and prosper. All you can do is keep learning to make smarter choices about risk.
posted by Pouteria at 9:40 PM on May 24, 2018 [11 favorites]
Note to self: do not annoy anastasiav.
Nor her (six foot six, very fit) husband.
Walk (or ride your farting ATV) down a wilderness trail you've never been on before. Walk a trail not on your map. Walk a trail not on -any- map.
Or just make your own trail.
When I was young and foolish and hence invulnerable, decades before mobile phones and emergency beacons were a thing, I used to ride my trail motorbike alone out along the highway, waaaaay out of my small home town, into some of the most remote, unpopulated, and unforgiving country on earth.
Then I would just turn off the sealed road at random and proceed through the often thick and rough natural bushland in whatever direction I felt like for hours. My only limits were water and fuel, and my own grossly underdeveloped teenage sense of self-preservation. Didn't even take a weapon of any kind into country with wild pigs and buffalo roaming free, and endless venomous critters (being Australia).
Never told anybody what I was doing, let alone where I was going.
It was as risky as hell, and completely defied all basic common sense. The sort of utter madness that should get you a custodial sentence and ten lashes if you recommended it to anybody else. But my luck and survival instinct held enough to never have any serious problems.
It was also some of my most formative experiences and precious memories, and I can honestly say that I have never regretted doing it.
Taking risks can kill you, brutally, and in a f'ing heartbeat. But they can make you as well. In fact, that is the only way to make yourself.
You must take risks to even merely survive, let alone move forward and prosper. All you can do is keep learning to make smarter choices about risk.
posted by Pouteria at 9:40 PM on May 24, 2018 [11 favorites]
This last time, the wellness coach did, in fact tell my (six foot six, very fit) husband that he should "get more exercise" based on his BMI.
One should not do anything based on one's BMI—a scientifically nonsensical number that conveys zero meaningful info re one's health.
A "wellness coach" should know this, but I'm not surprised they didn't. In the past month, I've heard 2 physician's assistants assure my 84 year old mother that her use of melatonin is fine "because it's natural". (Hey, ricin's natural, nonetheless, caster beans aren't a good source of fiber.)
posted by she's not there at 10:07 PM on May 24, 2018 [6 favorites]
One should not do anything based on one's BMI—a scientifically nonsensical number that conveys zero meaningful info re one's health.
A "wellness coach" should know this, but I'm not surprised they didn't. In the past month, I've heard 2 physician's assistants assure my 84 year old mother that her use of melatonin is fine "because it's natural". (Hey, ricin's natural, nonetheless, caster beans aren't a good source of fiber.)
posted by she's not there at 10:07 PM on May 24, 2018 [6 favorites]
I must read this book. I began firmly opting out of mammograms 10 years ago when I turned 40 and the medical establishment was still saying women needed to have yearly mammograms starting in their fourth decade. I had numerous reasons to distrust the need and proported benefits of mammograms so I refused to have them. I even got a letter from my insurance company threatening to drop me if I wouldn't get a mammogram. I held out anyway. It was only a year or two later that the medical establishment reversed their thinking on mammograms beginning at age 40 and no longer blanket recommends them citing potential for misdiagnosis and the potential for unnecessary treatment up to and including mastectomies . I also refuse to get all these other supposedly "age appropriate" tests done (lung cancer screening, colonoscopy etc., etc.). And don't even get me started on dentists and their scare tactics. I'm basically that dude in the movie, Baron Munchausen.
posted by WalkerWestridge at 10:45 PM on May 24, 2018 [7 favorites]
posted by WalkerWestridge at 10:45 PM on May 24, 2018 [7 favorites]
Wellness culture pisses me off. This is slightly off-topic, maybe? But when my mum was dying of cancer she got very into that Deliciously Ella woman, Ella Woodward, and tried to eat an all-organic, plant-based diet (not the friendliest thing for your insides, if you have bowel cancer). Ella Woodward doesn't directly make any claims that her diet can cure cancer tbf, but in the introduction to Deliciously Ella she specifically references a woman who manages their cancer using a plant-based diet. And I mean - it's nice that Woodward feels healthy living with long-term illness, I don't want anyone to be ill! And by all means eat some veg, why not. But I think the breathless way stuff about diet is covered and reported, and the fact that a lot of "wellness" people operate outside the medical system and therefore aren't challenged to provide evidence, means people are vulnerable to weird claims which (as far as I, not a doctor, can tell) have little scientific basis. It can be very seductive, especially when you're facing a pretty dire diagnosis, to think that something relatively basic which is in your control (diet, exercise) can save you from an illness which is totally out of your hands.
In our case I felt that the professionals from "mainstream" medicine we crossed (an oncologist, GP, district nurses, palliative consultant) were all very frank and realistic about my mum's prognosis and weren't pushing interventions which were unnecessary or my mum didn't want. She eventually died at home with us caring for her. Note - we are in the UK where cost-type incentives for intervention don't, I believe, exist in the same way as in the US, although there are certainly other pressures for medical professionals to push intervention & our health care system is far from perfect. Maybe we were just very lucky in the staff that we saw.
posted by the cat's pyjamas at 4:06 AM on May 25, 2018 [6 favorites]
In our case I felt that the professionals from "mainstream" medicine we crossed (an oncologist, GP, district nurses, palliative consultant) were all very frank and realistic about my mum's prognosis and weren't pushing interventions which were unnecessary or my mum didn't want. She eventually died at home with us caring for her. Note - we are in the UK where cost-type incentives for intervention don't, I believe, exist in the same way as in the US, although there are certainly other pressures for medical professionals to push intervention & our health care system is far from perfect. Maybe we were just very lucky in the staff that we saw.
posted by the cat's pyjamas at 4:06 AM on May 25, 2018 [6 favorites]
Margaret McCartney calls the medical side of this the "patient paradox" (also the title of her book about the phenomenon) - we increasingly test, screen and intervene with the well, while undertreating those who are actually ill.
This book sounds interesting, but I have been put off Ehrenreich's writing after reading "Dancing in the Streets: A History of Collective Joy". It has been a while since I read it so I can't remember the specifics, but I recall that the in the areas of history I knew about she was inaccurate, and the psychological/anthropological parts seemed like the very worst sort of evolutionary psychology. The overall impact was that I ended the book less convinced by her underlying thesis than I was when I started it.
posted by Vortisaur at 4:51 AM on May 25, 2018 [3 favorites]
This book sounds interesting, but I have been put off Ehrenreich's writing after reading "Dancing in the Streets: A History of Collective Joy". It has been a while since I read it so I can't remember the specifics, but I recall that the in the areas of history I knew about she was inaccurate, and the psychological/anthropological parts seemed like the very worst sort of evolutionary psychology. The overall impact was that I ended the book less convinced by her underlying thesis than I was when I started it.
posted by Vortisaur at 4:51 AM on May 25, 2018 [3 favorites]
I don't get it. What the fuck is wrong with wanting to live long as you can and enjoy your body on the ride? Why wouldn't I want to exercise and eat well? It's a fact that doing those things are good for my body, anyone who can't see that has got to be brain-dead.
And what's wrong with medical tests? Even just flippin' blood tests can give so. much. information to a person qualified to read them. And why wouldn't I trust my doctor? I have hired him, and if I don't trust him it's my fault that I'm still with him. I'm talking about my primary care doc. The guy loves me. He cares about me. He knows me incredibly well, and yet still he thinks I'm fine.
Then I have my cardiologist. Why wouldn't I want to do what he suggests I do? He has seen me dead, and brought me back from that. I love this guy. He loves me. We have fun. He saved my life. NO -- he gave me back my life. I am *totally* about medical interventions, being as how the three of them that my cardiologist gave me brought me back to life three times in July 2004. They have allowed me 14 more years of being here.
And being here is a good thing. I have my problems but goddamn it, I also have my joy. What the fuck is wrong with wanting to get and keep my body in the best shape possible? And test it for ways it might be going off the tracks, to I can steer it back. With qualified physicians help.
I think Ehrenreich has looped the fucking loop.
John Yossarian is my man here -- Yossarian said straight up that his goal is to live forever or die trying.
posted by dancestoblue at 5:38 AM on May 25, 2018 [2 favorites]
And what's wrong with medical tests? Even just flippin' blood tests can give so. much. information to a person qualified to read them. And why wouldn't I trust my doctor? I have hired him, and if I don't trust him it's my fault that I'm still with him. I'm talking about my primary care doc. The guy loves me. He cares about me. He knows me incredibly well, and yet still he thinks I'm fine.
Then I have my cardiologist. Why wouldn't I want to do what he suggests I do? He has seen me dead, and brought me back from that. I love this guy. He loves me. We have fun. He saved my life. NO -- he gave me back my life. I am *totally* about medical interventions, being as how the three of them that my cardiologist gave me brought me back to life three times in July 2004. They have allowed me 14 more years of being here.
And being here is a good thing. I have my problems but goddamn it, I also have my joy. What the fuck is wrong with wanting to get and keep my body in the best shape possible? And test it for ways it might be going off the tracks, to I can steer it back. With qualified physicians help.
I think Ehrenreich has looped the fucking loop.
John Yossarian is my man here -- Yossarian said straight up that his goal is to live forever or die trying.
posted by dancestoblue at 5:38 AM on May 25, 2018 [2 favorites]
Serious question. Did you read the article? Right at the beginning it says "Without opposing reasonable, routine maintenance, Ehrenreich observes that the care of the self has become a coercive and exploitative obligation: a string of endless medical tests, drugs, wellness practices, and exercise fads that threaten to become the point of life rather than its sustenance. Someone, obviously, is profiting from all this."
She's not opposed to living or taking good care of yourself. She's pointing out some problems with how that manifests in current American society.
posted by Mavri at 5:49 AM on May 25, 2018 [17 favorites]
She's not opposed to living or taking good care of yourself. She's pointing out some problems with how that manifests in current American society.
posted by Mavri at 5:49 AM on May 25, 2018 [17 favorites]
John Yossarian is my witj man here -- Yossarian said straight up that his goal is to live forever or die trying.
Oh, yeah, right. Let us all live until we are 150 years old with 150 year old brains, eyes, ears, teeth, hips, knees, shoulders, skin and hair.
That ought to work out fine, right ?
Get real.
Things fall apart.
End of story.
Forever.
posted by y2karl at 6:16 AM on May 25, 2018 [6 favorites]
Oh, yeah, right. Let us all live until we are 150 years old with 150 year old brains, eyes, ears, teeth, hips, knees, shoulders, skin and hair.
That ought to work out fine, right ?
Get real.
Things fall apart.
End of story.
Forever.
posted by y2karl at 6:16 AM on May 25, 2018 [6 favorites]
Smoke another cig.
Actually, please don't, if you have loved ones who will have to watch you go through proton radiation therapy for the tongue cancer you get because of those cigs because it will almost kill you when you can't eat and you have to get a feeding tube and then catch pneumonia but then you pull through and the cancer is beaten. Except it isn't and then two years later you're told that it's back and you have two choices: palliative chemo or a horrific surgery to remove the cancer from the very very very back of your tongue and you'll be 81 on the day of the surgery and your youngest kid is the one who has to deal with all this shit because reasons and she has her own shit going on because she has kids and a job and a husband and the fucking cancer came back.
Unless you decide, when the cancer diagnosis comes, that you're just going to let it take you. And even that comes with a shit ton of mental anguish for your family.
So how about you don't intentionally do things, LIKE SMOKE, that will probably end up badly for your loved ones?
posted by cooker girl at 7:08 AM on May 25, 2018 [7 favorites]
Actually, please don't, if you have loved ones who will have to watch you go through proton radiation therapy for the tongue cancer you get because of those cigs because it will almost kill you when you can't eat and you have to get a feeding tube and then catch pneumonia but then you pull through and the cancer is beaten. Except it isn't and then two years later you're told that it's back and you have two choices: palliative chemo or a horrific surgery to remove the cancer from the very very very back of your tongue and you'll be 81 on the day of the surgery and your youngest kid is the one who has to deal with all this shit because reasons and she has her own shit going on because she has kids and a job and a husband and the fucking cancer came back.
Unless you decide, when the cancer diagnosis comes, that you're just going to let it take you. And even that comes with a shit ton of mental anguish for your family.
So how about you don't intentionally do things, LIKE SMOKE, that will probably end up badly for your loved ones?
posted by cooker girl at 7:08 AM on May 25, 2018 [7 favorites]
....and look, it's the same fight as last time a review of this book was posted
posted by thelonius at 7:28 AM on May 25, 2018 [6 favorites]
posted by thelonius at 7:28 AM on May 25, 2018 [6 favorites]
Living in America and thinking your doctor loves you reminds me of the story John Roderick tells about his senile father who would go hang out at his mechanic's garage, and his mechanic would continually do unnecessary repairs on his old car and was billing him constantly. unless you are married to them, your doctor most assuredly does not love you, but they do love your insurance payouts.
posted by Space Coyote at 7:41 AM on May 25, 2018 [7 favorites]
posted by Space Coyote at 7:41 AM on May 25, 2018 [7 favorites]
So I guess this article is aimed at some tiny subset of people who have reached the top of Maslow's Hierarchy of Needs, because I'm pretty sure that the majority of people out there aren't doing anything with wellness, aren't getting even the necessary tests much less unncessary ones, and certainly aren't thwarted from death on their own terms by medical professionals.
Who is determining what 'unnecessary tests' are anyways? My guess is it's the same crew of antivaxxers and science deniers who claim that since it occasionally snows in May that there is no global warming and who are so cynical they are unable to accept that all the answers aren't 100% known, so everyone else is equally cynical and just out for some shallow profit motive.
posted by The_Vegetables at 8:07 AM on May 25, 2018 [1 favorite]
Who is determining what 'unnecessary tests' are anyways? My guess is it's the same crew of antivaxxers and science deniers who claim that since it occasionally snows in May that there is no global warming and who are so cynical they are unable to accept that all the answers aren't 100% known, so everyone else is equally cynical and just out for some shallow profit motive.
posted by The_Vegetables at 8:07 AM on May 25, 2018 [1 favorite]
The_Vegetables: Who is determining what 'unnecessary tests' are anyways? My guess is it's the same crew of antivaxxers and science deniers...
I've heard it most often from medical professionals when they aren't dealing directly with a patient. They recognize that a test will be invasive but its results won't lead to any change in treatment, or they recognize that the treatment will have a negative impact on quality of life in exchange for a small improvement in survival rates.
Sometimes the tests and treatments happen anyway because doing something seems better than not doing something, either to the doctor or to the patient. Sometimes it's just inertia, people performing the roles of doctor and patient.
A few times when my mother had expressed to me privately that she didn't want one treatment or another as her condition progressed, she wouldn't say anything while a doctor would tell her what they "needed" to do. I had to gently interject - "she does have the right to refuse treatment, correct? It's okay to balance quality of life against chance of treatment success, right?" - and the doctor would take a second or two to switch gears, to step out of the I'm-a-doctor-I-must-treat role. Only then, when we had gone off script, did real discussions happen.
If I hadn't put her objections into medically-recognizable phrases, I wonder if she would've gone down the path that so many elderly patients do: Not sure about whether she can speak up, resisting inarticulately, pegged as confused and uncompliant, and coerced into treatments that she didn't want or understand.
posted by clawsoon at 8:30 AM on May 25, 2018 [20 favorites]
I've heard it most often from medical professionals when they aren't dealing directly with a patient. They recognize that a test will be invasive but its results won't lead to any change in treatment, or they recognize that the treatment will have a negative impact on quality of life in exchange for a small improvement in survival rates.
Sometimes the tests and treatments happen anyway because doing something seems better than not doing something, either to the doctor or to the patient. Sometimes it's just inertia, people performing the roles of doctor and patient.
A few times when my mother had expressed to me privately that she didn't want one treatment or another as her condition progressed, she wouldn't say anything while a doctor would tell her what they "needed" to do. I had to gently interject - "she does have the right to refuse treatment, correct? It's okay to balance quality of life against chance of treatment success, right?" - and the doctor would take a second or two to switch gears, to step out of the I'm-a-doctor-I-must-treat role. Only then, when we had gone off script, did real discussions happen.
If I hadn't put her objections into medically-recognizable phrases, I wonder if she would've gone down the path that so many elderly patients do: Not sure about whether she can speak up, resisting inarticulately, pegged as confused and uncompliant, and coerced into treatments that she didn't want or understand.
posted by clawsoon at 8:30 AM on May 25, 2018 [20 favorites]
I would ask if she doesn't want the treatments, what is she doing at the doctor? They don't force you to go there. My experience with my relatives that spend lots of time at doctors offices is that they are trying like hell to live for whatever reasons, not attempting to talk a doctor down from letting them die.
My relatives who were ready to die visited the doctor as much as any healthy person does. Which is to say not that often.
posted by The_Vegetables at 10:42 AM on May 25, 2018 [1 favorite]
My relatives who were ready to die visited the doctor as much as any healthy person does. Which is to say not that often.
posted by The_Vegetables at 10:42 AM on May 25, 2018 [1 favorite]
I do accept that there are both types of people - those tired of life and those who want one more second on this earth.
posted by The_Vegetables at 10:44 AM on May 25, 2018
posted by The_Vegetables at 10:44 AM on May 25, 2018
Who is determining what 'unnecessary tests' are anyways?
It is well-established that screening certain populations for certain diseases does not improve the death rate from those diseases. Something more of a judgment call, but still based on statistical observation, are those cases where screening the population may very modestly decrease the death risk from the disease, but at a large cost for the tests themselves and then unnecessary retesting for false positives, not to mention other forms of harm or distress to people who do not have the disease but falsely test positive. This is some really basic public health stuff.
Ten years ago, I went to a new doctor with a chronic problem. She ordered an MRI to rule out an extremely unlikely possible cause (if it had been the cause of the symptom, I would have become seriously ill years earlier). On that MRI was an unrelated incidental finding re: another organ. Because that incidental finding might have been the precursor to a terminal illness, I had major surgery (eight days in the hospital, missed two months of work). I had to think about it carefully, weigh the pros and cons, and ultimately make the best decision I could, but the worst outcome in my scenario is so poor that it's actually very hard for doctors to ethically study what the likely outcome of not engaging in aggressive treatment is, so not a lot of data was available to me. We could well find out in twenty years that I was actually at sufficiently low risk that the best course of treatment would simply have been observation. Anyway--that MRI was unnecessary testing. It led, completely by accident, to a finding that led to major surgery that may or may not have been necessary. And a much older or weaker person could have suffered a permanent decline in quality of life as a result of going through that surgery. That's how things spiral medically.
posted by praemunire at 11:16 AM on May 25, 2018 [8 favorites]
It is well-established that screening certain populations for certain diseases does not improve the death rate from those diseases. Something more of a judgment call, but still based on statistical observation, are those cases where screening the population may very modestly decrease the death risk from the disease, but at a large cost for the tests themselves and then unnecessary retesting for false positives, not to mention other forms of harm or distress to people who do not have the disease but falsely test positive. This is some really basic public health stuff.
Ten years ago, I went to a new doctor with a chronic problem. She ordered an MRI to rule out an extremely unlikely possible cause (if it had been the cause of the symptom, I would have become seriously ill years earlier). On that MRI was an unrelated incidental finding re: another organ. Because that incidental finding might have been the precursor to a terminal illness, I had major surgery (eight days in the hospital, missed two months of work). I had to think about it carefully, weigh the pros and cons, and ultimately make the best decision I could, but the worst outcome in my scenario is so poor that it's actually very hard for doctors to ethically study what the likely outcome of not engaging in aggressive treatment is, so not a lot of data was available to me. We could well find out in twenty years that I was actually at sufficiently low risk that the best course of treatment would simply have been observation. Anyway--that MRI was unnecessary testing. It led, completely by accident, to a finding that led to major surgery that may or may not have been necessary. And a much older or weaker person could have suffered a permanent decline in quality of life as a result of going through that surgery. That's how things spiral medically.
posted by praemunire at 11:16 AM on May 25, 2018 [8 favorites]
The_Vegetables: I would ask if she doesn't want the treatments, what is she doing at the doctor? They don't force you to go there.
Mostly because me and my sister finally convinced her that barely being able to talk or swallow anymore might indicate that something was wrong, something that a doctor might be able to help with. And then we set up the appointments, and took her, and made her feel comfortable that we wouldn't try to make her do anything she didn't want to do.
If not for that, she wouldn't have gone.
My experience with my relatives that spend lots of time at doctors offices is that they are trying like hell to live for whatever reasons, not attempting to talk a doctor down from letting them die.
That would've been my Dad.
posted by clawsoon at 11:38 AM on May 25, 2018
Mostly because me and my sister finally convinced her that barely being able to talk or swallow anymore might indicate that something was wrong, something that a doctor might be able to help with. And then we set up the appointments, and took her, and made her feel comfortable that we wouldn't try to make her do anything she didn't want to do.
If not for that, she wouldn't have gone.
My experience with my relatives that spend lots of time at doctors offices is that they are trying like hell to live for whatever reasons, not attempting to talk a doctor down from letting them die.
That would've been my Dad.
posted by clawsoon at 11:38 AM on May 25, 2018
And, as it happens, it was my Dad who was drawn to the woo. First a few years of woo - some electrical frequency stuff that was supposed to cure everything - and when it was finally obvious that wasn't working, all of the pills, and then all of the pills to counteract the effects of all the other pills. We talked with him about whether he was getting too much treatment, just like we talked with my mother about whether she wasn't getting enough, but ultimately we respected them as adults to make their own decisions.
Looking at the process of dying that they both went through, I'd prefer to go like my mother did, as hard as it was. Hopefully I'll get that choice.
Their different attitudes to treatment didn't seem to depend so much on their faith or not in medical science, but in their attitudes about life and death.
posted by clawsoon at 11:50 AM on May 25, 2018 [1 favorite]
Looking at the process of dying that they both went through, I'd prefer to go like my mother did, as hard as it was. Hopefully I'll get that choice.
Their different attitudes to treatment didn't seem to depend so much on their faith or not in medical science, but in their attitudes about life and death.
posted by clawsoon at 11:50 AM on May 25, 2018 [1 favorite]
I haven’t read this book as of yet, but from the article it seems like a piece by someone who has been relatively healthy and abled through their life, talking about a system that absolutely centers other people who are also healthy and abled and who have real choices about what they’re doing for care.
This in particular:
Some will seek or accept treatments that won’t help with their condition, simply because so much power is invested in the doctor.
Is absolutely the critique of someone who will not have dire consequences for declining to do what their doctor tells them. As someone with a chronic illness, I don’t have much choice about how often I see my doctors if I want to keep working and functioning, and trying a bunch of things that may not work in the hope that one will has defined my life for the last several years.
I guess I expected better because of how much I liked Brightsided and its critique of the relentless expectations of positivity, but here she’s assuming a much better baseline than a lot of people have.
posted by bile and syntax at 12:28 PM on May 25, 2018 [5 favorites]
This in particular:
Some will seek or accept treatments that won’t help with their condition, simply because so much power is invested in the doctor.
Is absolutely the critique of someone who will not have dire consequences for declining to do what their doctor tells them. As someone with a chronic illness, I don’t have much choice about how often I see my doctors if I want to keep working and functioning, and trying a bunch of things that may not work in the hope that one will has defined my life for the last several years.
I guess I expected better because of how much I liked Brightsided and its critique of the relentless expectations of positivity, but here she’s assuming a much better baseline than a lot of people have.
posted by bile and syntax at 12:28 PM on May 25, 2018 [5 favorites]
Who is determining what 'unnecessary tests' are anyways? My guess is it's the same crew of antivaxxers and science deniers
No, it tends to be the kind of people whose research about whether it makes sense to recommend mammograms for women 75 and older gets published in JAMA.
posted by Lexica at 12:48 PM on May 25, 2018 [8 favorites]
No, it tends to be the kind of people whose research about whether it makes sense to recommend mammograms for women 75 and older gets published in JAMA.
posted by Lexica at 12:48 PM on May 25, 2018 [8 favorites]
I'm pretty sure that the majority of people out there aren't doing anything with wellness, aren't getting even the necessary tests much less unncessary ones, and certainly aren't thwarted from death on their own terms by medical professionals.
My great aunt had cancer treatments forced upon her; she was 89, demented, on her third bout with cancer (it just kept showing back up in new, weird places). She talked a lot about how she just wanted to go be with her husband and dog, who were both long dead. But her children couldn’t let go, and medical professionals were more than happy to put her wretched body through chemo and radiation AGAIN instead of palliative care.
That was twenty years ago. Last week, a dear friend’s MIL started the cancer treatments her doctor forced her into through a series of misleading conversations. She’s got stage 4 cancer throughout her body and even with extremely aggressive treatment she stands to live another six months. She just wants to take palliative care and not be in medical misery in her last months, but. Apparently that’s not allowed to happen unless you’re rich enough to go opinion hunting among oncology teams.
Hell, three months ago when my grandmother was very clearly dying I had to fight with the nursing home about converting her to hospice instead of forcing her to keep going through physical rehab that was making things worse, not better.
I wish I lived in your world. It sounds a hell of a lot nice than the real one.
posted by palomar at 1:06 PM on May 25, 2018 [4 favorites]
My great aunt had cancer treatments forced upon her; she was 89, demented, on her third bout with cancer (it just kept showing back up in new, weird places). She talked a lot about how she just wanted to go be with her husband and dog, who were both long dead. But her children couldn’t let go, and medical professionals were more than happy to put her wretched body through chemo and radiation AGAIN instead of palliative care.
That was twenty years ago. Last week, a dear friend’s MIL started the cancer treatments her doctor forced her into through a series of misleading conversations. She’s got stage 4 cancer throughout her body and even with extremely aggressive treatment she stands to live another six months. She just wants to take palliative care and not be in medical misery in her last months, but. Apparently that’s not allowed to happen unless you’re rich enough to go opinion hunting among oncology teams.
Hell, three months ago when my grandmother was very clearly dying I had to fight with the nursing home about converting her to hospice instead of forcing her to keep going through physical rehab that was making things worse, not better.
I wish I lived in your world. It sounds a hell of a lot nice than the real one.
posted by palomar at 1:06 PM on May 25, 2018 [4 favorites]
I don't get it.
I'm not, like, a regular polemic. I'm a cool polemic.
common sense and/or "common sense" in the guise of rebel contrarianism has an evergreen appeal. ehrenreich's right about some things and worth reading on some things, but "radical critique" is pushing it, on this topic. some of what she says is pretty widely agreed on, some of it's debatable. Her attitude towards late-life medical interventions is one shared by all of my once elderly, now-dead relatives, but none of them were journalists. It is not one that needs to be shared by everyone. The exercise bit gets to be the pull quote because it's mildly inflammatory and is entirely about her personal tastes. which are as legitimate as anyone's but have no particular relevance to those who don't share them. there's a continuum with ehrenreich's best work at one end and andy rooney at the other end. she is not so firmly ensconced at the good end as she might be.
as the New Republic says -- not in these words -- at least someone's lecturing old people about their dumb self-care habits instead of young people, for a change.
posted by queenofbithynia at 1:57 PM on May 25, 2018 [3 favorites]
I think there is a deep thread of connection between "wellness", approaches to community health that blame individuals, and the fascist notion that it's your duty to be healthy for the State.
Be well. Take responsibility. You can fight cancer, fight fight fight. Ooh, tax sugar, it's poor people's fault if they get fat and that will teach them. Be well, it's not a blessing, it's a command.
I look forward to reading this book.
posted by i_am_joe's_spleen at 2:29 PM on May 25, 2018 [4 favorites]
Be well. Take responsibility. You can fight cancer, fight fight fight. Ooh, tax sugar, it's poor people's fault if they get fat and that will teach them. Be well, it's not a blessing, it's a command.
I look forward to reading this book.
posted by i_am_joe's_spleen at 2:29 PM on May 25, 2018 [4 favorites]
Read the book recently and also saw Ehrenreich speak at our local library. Although I have loved other books by her, this one struck me as an unfocused ramble-and-rant. I liked the premise, but she emphasized when she spoke that a lot of her stance has to do with how old she is, and also with having had to deal with the awfulness of chemotherapy, which she said on the whole she wouldn't go through again. She has also over-fond of the pithy-old-fart one-liner.
posted by Peach at 3:02 PM on May 25, 2018 [3 favorites]
posted by Peach at 3:02 PM on May 25, 2018 [3 favorites]
Who is determining what 'unnecessary tests' are anyways? My guess is it's the same crew of antivaxxers and science deniers
No, it tends to be the kind of people whose research about whether it makes sense to recommend mammograms for women 75 and older gets published in JAMA.
Yeah, my impression is that this has been discussed A Whole Lot in medical circles in recent years. There are a number of dynamics - some the result of purely good intentions, some not - that lead to patients getting all the tests, which in turn lead to a lot of interventions of unclear expected value. At some point people started realizing that the sum of false positives and unnecessary interventions can end up doing more net harm than good.
If Ehrenreich is off the mark about something it's maybe coming too close to implying that the field of medicine doesn't already know/talk about these limitations.
posted by atoxyl at 5:52 PM on May 25, 2018 [2 favorites]
No, it tends to be the kind of people whose research about whether it makes sense to recommend mammograms for women 75 and older gets published in JAMA.
Yeah, my impression is that this has been discussed A Whole Lot in medical circles in recent years. There are a number of dynamics - some the result of purely good intentions, some not - that lead to patients getting all the tests, which in turn lead to a lot of interventions of unclear expected value. At some point people started realizing that the sum of false positives and unnecessary interventions can end up doing more net harm than good.
If Ehrenreich is off the mark about something it's maybe coming too close to implying that the field of medicine doesn't already know/talk about these limitations.
posted by atoxyl at 5:52 PM on May 25, 2018 [2 favorites]
Even though she showed no signs of sleep apnea, her dentist wanted her to get a test for it, “after which I could buy the treatment from her: a terrifying skull-shaped mask that would supposedly prevent sleep apnea and definitely extinguish any last possibility of sexual activity.” The risk of sudden death in her sleep, she decides, is tolerable. She turns down colonoscopies, certain that she’ll die of something else before colon cancer kills her anyway. She fires her doctor after he suspends his ordinary practice and offers “concierge care” instead—pricey, constant access and a heightened testing regime.
Sleep apnea is no joke. And the mister's CPAP mask is sexy as hell because it makes him no longer like a dying elephant, and also increases his chances of being alive for sexytimes.
I watched my husband's mother die of colon cancer at the age of 58, when her only grandchild was 18 months old, so fuck right off with that unnecessary procedure bullshit.
There are some unnecessary interventions, sure. My grandfather ignored his prostate cancer for over a decade and died of unrelated causes in his mid eighties. My father was diagnosed with it in his fifties and treated it, and is cancer free twenty years later. His much younger brother then got diagnosed with it in his fifties, is ignoring it, and is probably going to die soon.
On the other hand, with a personal history of rupturing ovarian cysts, endometriosis, and PMDD, and a maternal family history of ovarian and breast cancer, after ten years of saying this is what I want, I finally have an appointment to discuss surgical options, having tried every non-surgical recommended to me since I was 12.
I sometimes feel, as I did when reading Nickel and Dimed, that Ehrenreich and I live in very different worlds.
posted by Ruki at 9:54 PM on May 25, 2018 [5 favorites]
Sleep apnea is no joke. And the mister's CPAP mask is sexy as hell because it makes him no longer like a dying elephant, and also increases his chances of being alive for sexytimes.
I watched my husband's mother die of colon cancer at the age of 58, when her only grandchild was 18 months old, so fuck right off with that unnecessary procedure bullshit.
There are some unnecessary interventions, sure. My grandfather ignored his prostate cancer for over a decade and died of unrelated causes in his mid eighties. My father was diagnosed with it in his fifties and treated it, and is cancer free twenty years later. His much younger brother then got diagnosed with it in his fifties, is ignoring it, and is probably going to die soon.
On the other hand, with a personal history of rupturing ovarian cysts, endometriosis, and PMDD, and a maternal family history of ovarian and breast cancer, after ten years of saying this is what I want, I finally have an appointment to discuss surgical options, having tried every non-surgical recommended to me since I was 12.
I sometimes feel, as I did when reading Nickel and Dimed, that Ehrenreich and I live in very different worlds.
posted by Ruki at 9:54 PM on May 25, 2018 [5 favorites]
What happened to when she was living with a wild god? She doesn't seem to get meditation, probably because of the industry built around it.
posted by Obscure Reference at 9:56 AM on May 27, 2018
posted by Obscure Reference at 9:56 AM on May 27, 2018
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