I just finished reading Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer by Barbara Ehrenreich.
She’s also the author of Nickel and Dimed, a book about welfare reform and the quest for fair wages. So I was surprised to learn that she has a PhD in cellular biology!
Ehrenreich brings her scientific chops to Natural Causes and is a welcome addition to a growing collective of scientists, physicians and patients who think our healthcare system overscreens, overdiagnoses, and overtreats.
Healthcare is on track to eat up 20% of our nation’s GDP. And it probably already costs the average family more than that.
Which begs the questions “How much healthcare do we really need?”
Are we getting our money’s worth by living happier, healthier, more productive lives? (I don’t count just living longer as a useful metric.)
Or are we just living medical test to medical test hoping to keep death at arm’s length? At least until we have to die of something and then realize too late how much time, money and emotional energy we’ve sacrificed to our massive healthcare industrial complex.
Everything has a diagnosis
Ehrenreich decries the trend of medicalization, or pinning a medical diagnosis on every human condition. Feeling sad? You suffer from depression. Heartburn? It must be GERD. Getting old? You suffer from osteopenia, arthritis, low-testosterone, heart disease or any number of conditions that are just part of the aging process.
And if there weren’t enough diagnoses before, drug companies figured out that attaching the prefix “pre” to conditions more than doubles their potential market: pre-hypertension, pre-diabetes, pre-dementia, pre-cancerous.
Related post: “Slow Medicine”—One size doesn’t fit all
Health has become a commodity, and patients have become “healthcare consumers.” I can’t pick up a magazine or watch TV without seeing an ad for a prescription drug, most showing models and actors who are healthy, happy and apparently wealthy. No wonder patients demand the newest and most expensive drugs on the market.
The media is full of health advice, as well. Stories tell us how many minutes of exercise we need every day for optimal health, even though this is so variable from person to person as to be almost meaningless. Other articles tell us what we should or shouldn’t be eating to prolong our lives. Until another study shows the exact opposite.
New evidence also shows that routine screening tests, such as mammograms, colonoscopies, PSAs, and DEXA scans, don’t necessarily save lives or money. They might cause more harm. And unnecessary screening and subsequent overdiagnosis and overtreatment certainly cost us financially.
Related post: Atul Gawande—Overtreatment, “Overkill”
Redefine what makes life worth living
I’ve spent a lot of time over the past decade reflecting on and refining my health care philosophy and goals. If you’ve read my About page, you understand why I am more and more wary of getting sucked into the healthcare machine.
I once worked for a surgeon who used to tell patients, “If it ain’t broke, don’t fix it.” (This was many years ago. I don’t think she could stay in practice with an attitude like that today.)
But I’ve taken that for my own health care motto, and judging by her book, Ehrenreich has, too.
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.
As we age, my husband and our circle of friends have begun talking about our QTR—quality time remaining. Like Ehrenreich, we don’t want to spend it feeding our gluttonous healthcare system.
As the time that remains to me shrinks, each month and day becomes too precious to spend in windowless waiting rooms and under the cold scrutiny of machines. Being old enough to die is an achievement, not a defeat, and the freedom it brings is worth celebrating.
Amen to that.
Here are three more books by leaders in the less-is-more healthcare crusade: