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13 min 08 sec
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Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer

Questions the yearly checkups, cancer screenings, gym routines and anti-aging plans most of us accept. It shows who profits from them and why accepting the limits of the body can leave more time for a good life.

Table of Content

If every birthday seems to bring another appointment, another scan and another reason to worry, Barbara Ehrenreich offers a different way to spend your later years. In Natural Causes, the essayist explains why, at 76, she stopped getting yearly exams, cancer screenings and smear tests, even though she had health insurance. Her view is that after about 75, routine testing costs more in time and fear than it gives back.

That personal choice opens a larger argument. Much of what we are told to do for our health, from annual checkups to daily gym sessions to the fight against wrinkles, is driven by profit, competition and social status at least as much as by evidence.

Ehrenreich follows that pattern through doctors’ offices, delivery rooms, health clubs and our own distracted minds. What she offers is a set of questions to ask before the next test or training plan, and permission to treat old age as a season worth enjoying.

A false alarm left Ehrenreich so anxious that the police fined her for it. Then she heard about a 100-year-old woman still being screened, and started asking who all this testing is really for.

Billions go into checkups every year on the promise that early detection saves lives. Ehrenreich looks at the evidence behind two of the best-known screenings and finds a gap between the promise and the record.

For decades, women giving birth went through a fixed series of procedures that doctors called standard care. Ehrenreich checks each one against its effects and reaches a troubling conclusion about whom the routine served.

Health clubs take in billions a year, and most people feel guilty when they skip a workout. Ehrenreich traces the fitness boom to a shift in the economy that has little to do with health.

Mind over matter is the hope behind every diet and every early alarm. A study sponsored by a technology company suggests the mind doing the controlling has lost a third of its staying power.

Retirement once meant a garden, a hammock and long dinners with family. Today it often means six workouts a week and a strict diet. Ehrenreich asks what that trade costs, and what it hides.

Natural Causes keeps returning to one hard question about the health advice that fills modern life: who benefits? In Ehrenreich’s telling, the answer is often a profitable testing industry, a competitive economy and a culture that ranks people by how young and fit they look. The patient, the new mother and the older adult come last. Beneath it all sits a belief that the body can be controlled without end, if only we test enough, train enough and resist enough. Ehrenreich, writing at 76, rejects that belief and chooses time over control.

Her book supports a few concrete moves. Before a routine screening, ask whether it lowers deaths or simply finds more to treat, and whether the result would change what you do at your age. Notice when a workout is serving status more than health. Protect your attention from the constant switching that devices invite. And treat the later decades as a period with its own rewards, the honesty Friedan described and the late work Segal saw in artists.

The woman who was once fined for driving while frightened by a false alarm now spends those hours on living. For Ehrenreich, that is the better use of a life that was always going to end.

About this book

What is this book about?

Most adults carry a long list of health duties: yearly exams, cancer screenings, regular workouts and a constant effort to look and feel younger. Barbara Ehrenreich, writing at 76, asks what all of it is really for. Now in her seventies, she has stopped routine medical testing, and in this book she explains why. Her argument is that much of today's wellness culture rests on profit, competition and social status as much as on evidence. She looks at the money behind screening tests, the weak record of yearly mammograms and prostate checks, the rituals of the delivery room, the fitness boom that began in the 1980s, the shrinking attention span of the wired mind, and a culture that treats aging as a failure. Readers get a sharp set of questions to bring to the next doctor's appointment or training plan, and a different way to see old age: as a stage with its own rewards, from greater honesty to some of the best creative work of a life, instead of a decline to be fought every day.

Book Information

Rating:

Genre:

Health & Nutrition, Social Issues

Topics:

Fitness, Longevity, Medicine

Publisher:

Hachette

Language:

English

Narrator:

Walter

First published:

April 10, 2018

Pages:

272

Length:

13 min 08 sec

Get the book:

Amazon

Who it's for

  • Adults over sixty

    Adults in their sixties and beyond weighing whether yet another screening is worth the worry.

  • Guilty about skipped workouts

    People who feel guilty about every skipped workout and want to know where that pressure comes from.

  • Caring for aging parents

    Anyone caring for aging parents who wants a gentler view of growing old.

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About the Author

Barbara Ehrenreich

Barbara Ehrenreich was an American author, columnist and essayist, born in Butte, Montana, in 1941, who died in 2022. She wrote 21 books and received a Lannan Literary Award and the Erasmus Prize. She is best known for Nickel and Dimed, her 2001 account of three months spent trying to get by on low-paid jobs. She was a prominent figure in the Democratic Socialists of America in the 1980s and early 1990s.

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Ratings & Reviews

Ratings at a glance

2.6

Overall score based on 107 ratings.

What people think

Listeners find this work to be intellectually stimulating and well-documented, showing appreciation for the author's humor and writing style. Feedback regarding readability is split; while some find it an easy listen, others characterize the experience as boring. Similarly, views on the message and its emotional depth vary, with some finding the material valuable while others feel it represents a waste of their time and money.

Top reviews

Willow

To be fair, you have to be in a certain headspace to appreciate Ehrenreich’s grim but liberating outlook on mortality. This isn't your typical "live to 100" self-help fluff; it’s a rigorous, often biting analysis of why we spend so much energy trying to control the uncontrollable. Her background in cellular immunology shines in the later chapters. While some reviewers found the talk of macrophages "boring," I found it illuminating. It forces you to realize that our bodies aren't perfect machines. Our own cells can betray us regardless of how much kale we eat or how many spin classes we attend. This book helped me reframe my approach to healthcare from one of fear-based compliance to informed autonomy. It’s a brave, necessary challenge to the "wellness" industry that profits from our terror of the inevitable. Truly a five-star read for those who want the uncomfortable truth.

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Selin

After hearing Ehrenreich discuss her PhD background, I was prepared for the deep dive into cellular biology. Honestly, it’s refreshing to see someone tackle the absurdity of our current wellness obsession from a place of scientific authority. The section on how macrophages—the very cells meant to protect us—can actually aid and abet cancer was a total eye-opener. It completely undermines the idea that we can control our health through sheer force of will or expensive "superfoods." The writing is dense in the middle, but the payoff is a much more realistic understanding of our own mortality. I can see why people who wanted a light self-help book would be disappointed. This is a challenging, cynical, and ultimately grounded look at the biology of dying. It isn't perfect, and the tangents about LSD felt a bit out of left field, but the core science is solid and well-researched.

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Wipawan

Picked this up because I’m tired of being told that my morning coffee or lack of kale is going to kill me by Tuesday. Ehrenreich delivers exactly the kind of snarky, well-researched takedown of the wellness industry that I was hoping for. The way she dismantles the cult of "successful aging" is both hilarious and deeply depressing. Just my two cents, but we’ve reached a point where we treat death as a personal failure rather than a biological certainty. I didn't even mind the deep dive into the behavior of cells, though it definitely slows the pace down. Her point that our own bodies are essentially "nasty little bastards" that don't always follow the rules of healthy living is a sobering thought. It’s a bit disorganized, shifting from medical exams to cellular biology to smoking, but the voice is authentic. Definitely worth reading if you're feeling medical fatigue.

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Tanyaporn

Not what I expected, especially the ending where things take a sharp turn into psychedelic therapy and the ego. I actually found the discussion on LSD and the 'meaning of the soul' surprisingly poignant given the earlier cynicism. Ehrenreich argues that we need to 'get over ourselves,' which is a tough pill for the modern, self-obsessed wellness seeker to swallow. Not gonna lie, the middle section on macrophages was a bit of a dense hurdle to clear. If you can push through the heavy science, there is a lot of dark humor and wisdom here. She manages to take a swipe at everyone from Silicon Valley 'mindfulness' bros to the medical establishment. It is a messy book, but the core message about the certainty of death is one we all need to hear. It’s provocative, unsentimental, and deeply human. I'll be thinking about this one for a long time.

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Air

Frankly, the takedown of the 'mindfulness' craze was worth the price of admission alone. Ehrenreich is at her best when she is skewering the way Silicon Valley and celebrities like Gwyneth Paltrow have commodified our peace of mind. She exposes the 'wellness epidemic' for what it is: a way to keep us obsessed with our own bodies while ignoring the larger social context of health. In my experience, the book gets a little bogged down when it starts talking about the intricacies of the cell and the history of the stethoscope. Some of those segments felt like they belonged in a different manuscript entirely. But the overall message—that we are killing ourselves to live longer—is powerful and timely. It’s a messy, passionate, and occasionally boring book that nonetheless manages to say something profound about the human condition. I’m glad I took the time to finish it despite the tangents.

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Mia

Natural Causes starts out with a provocative premise about the futility of over-medicalizing our later years. Ehrenreich is undeniably sharp, and her critique of "preventative" screenings like mammograms or bone density tests for those of us already "old enough to die" feels like a breath of fresh air. However, the book loses its momentum when it wanders into dense, academic territory regarding cellular biology. Look, I appreciate that she has a PhD, but the transition from a social critique of wellness culture to a long-winded lecture on macrophages felt jarring. One moment we are talking about the "rituals of humiliation" in a doctor's office, and the next we are buried in immunology. I found the first half far more engaging than the back half. It’s an important conversation to have, even if the execution feels a bit scattered in places. It left me with more questions than answers.

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Ott

The chapter on 'Rituals of Humiliation' really struck a chord with me because it highlights the power imbalance in modern doctor-patient relationships. Personally, I have felt that exact same sense of demeaning vulnerability during routine exams that Ehrenreich describes so vividly. Her writing is sharp and her wit is as dry as ever, which makes the first half of the book a delight to read. But then we hit the science. The transition into a long, incredibly detailed discussion of macrophages and cellular treason felt like I’d accidentally swapped books mid-stream. It’s hard to stay connected to her message when the narrative is this fragmented. I wanted more about the social context of death and less about the inner workings of cells. It’s an okay read for the social commentary, but it lacks the focus of her best work. It feels a bit rushed.

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Sayan

As someone who has recently hit that age where every doctor visit feels like an interrogation, I found the first half of this book incredibly validating. Ehrenreich tackles the 'wellness epidemic' with a level of skepticism that is sorely needed in a world obsessed with eternal youth. She correctly identifies how we blame the elderly for their own decline, as if they could just 'mindfulness' their way out of biology. However, the book's structure is undeniably sloppy. It feels like three different essays roughly stitched together with some leftover thoughts on LSD and the soul. While her points about the medical industry are well-taken, the long digressions on immunology make it a chore to finish for a layperson. I’m glad I read it for the perspective, but I don’t think I’d recommend it to anyone looking for a cohesive argument. It’s more of a thought-starter than a finished product.

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Bun

Ever wonder why an author with such a brilliant track record would suddenly pivot into a confusing lecture on immunology? I’ve admired Ehrenreich for years, but this felt like a collection of disjointed essays rather than a cohesive book. The first few chapters offer a fascinating critique of the 'medicalization' of everyday life, but then the momentum drops off a cliff. We get stuck in a massive digression about cellular behavior that belongs in a textbook, not a popular non-fiction book about aging. Truth be told, I struggled to see how the 'meaning of the soul' tied back to her initial point about mammograms. It felt like she had a word count to hit and just threw in everything she’d been thinking about lately. It’s not a total loss because her prose is always elegant, but it is certainly a slog compared to her earlier work like Nickel and Dimed.

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Sin

This book was easily the most frustrating thing I’ve picked up all year. I expected an insightful look at how society handles the inevitable process of aging, but instead, I got a hostile rant that completely lacks objectivity. Ehrenreich blatantly ignores any scientific data that doesn't fit her "medicine is a scam" narrative. Telling people to skip life-saving screenings is dangerous and irresponsible, especially coming from someone with such a large platform. She writes well enough, but the bias is so thick that the text becomes nearly unreadable. The section on smoking being a "self-soothing" act for the working class felt like a bizarre defense of a known killer. If you want a well-researched book on mortality, look elsewhere. This is just a collection of personal grievances dressed up as a scientific exposé. It was a total waste of my time and money.

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Questions about this book

Ehrenreich argues that much of today’s wellness culture, from yearly checkups and cancer screenings to gym routines and anti-aging diets, is driven by profit, competition and social status as much as by evidence. She stopped routine testing in her seventies and makes the case that accepting the body’s limits leaves more time to enjoy life, especially in old age.

She believed that after about 75, testing no longer made sense for her. She preferred to spend her time on things she enjoyed rather than on tests, anxious waits and possible treatments. A false-positive mammogram left her so worried for weeks that she was fined for distracted driving, and around 70 she stopped getting mammograms.

Ehrenreich notes that the Susan G. Komen Foundation links yearly mammograms to better five-year survival, but says no study has shown they significantly lower breast cancer deaths. She finds no evidence that prostate screening has cut deaths from prostate cancer, and points to a 2014 UCLA study showing that almost half of the treated men over 66 would probably not have survived long enough for the cancer to turn dangerous.

She traces the fitness boom to the 1980s, when Western economies grew more competitive and job security fell. In that climate, being fitter than others feels like a matter of survival. Fitness has also become a middle-class status marker, since healthy food and gym memberships cost money, while lounging on the couch is seen as low class. Americans spend $26 billion a year on health clubs.

Before a routine test, ask whether it reduces deaths or only finds more to treat, and whether the result would change your choices at your age. Check whether your workouts serve your health or your image. Limit constant task switching on devices, which neuroscientists link to shorter attention and poorer sleep. And treat later life as a stage with its own rewards.

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Natural Causes

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