Barbara Ehrenreich Versus Preventive Care, American Style

Barbara Ehrenreich posted an important essay last week, Why I’m Giving Up on Preventive Care. Ehrenreich first out of emotional resistance, then more consciously, has stopped getting most preventive tests that the medical industrial complex pushes on adults, particularly middle aged adults. I strongly encourage you to read the entire essay. Here is the core of her argument:

I was going against the grain for my particular demographic. Most of my educated, middle-class friends had begun to double down on their health-related efforts at the onset of middle age, if not earlier. They undertook exercise or yoga regimens; they filled their calendars with upcoming medical tests and exams; they boasted about their “good” and “bad” cholesterol counts, their heart rates and blood pressure. Mostly they understood they the task of aging to be self-denial, especially in the realm of diet, where one medical fad, one study or another, condemned fat and meat, carbs, gluten, dairy, or all animal-derived products. In the health-conscious mind-set that has prevailed among the world’s affluent people for about four decades now, health is indistinguishable from virtue, tasty foods are “sinfully delicious,” while healthful foods may taste good enough to be advertised as “guilt-free.” Those seeking to compensate for a lapse undertake punitive measures like fasts, purges, or diets composed of different juices carefully sequenced throughout the day.

I had a different reaction to aging: I gradually came to realize that I was old enough to die… Once I realized I was old enough to die, I decided that I was also old enough not to incur any more suffering, annoyance, or boredom in the pursuit of a longer life. 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.

She goes on about mammograms, one of my pet peeves, for some but not all of the good reasons to be leeru of them. She points out that they are painful and put radiation into your boobs…which in and of itself can promote the growth of cancers. But she oddly omits what I think is the biggest argument against them: they are a lousy test. They produce lots of false positive. They are good at catching slow-growing “cancers” that you will die with, not of, and are not so hot at catching the fast growing ones that are dangerous. And what is better at detecting those early? A manual exam by someone who has examined lots of breasts, but that doesn’t seem scientific enough to many patients, and thermal imaging.

So why are mammograms a test that doctors push on patients, as opposed to the alternatives? I think it has a lot to do with the installed base of equipment.

And another telling example:

So I grudgingly conceded that undergoing the test, which is noninvasive and covered by my insurance, might be preferable to immobility and institutionalization. The result was a diagnosis of “osteopenia,” or thinning of the bones, a condition that might have been alarming if I hadn’t found out that it is shared by nearly all women over the age of 35. Osteopenia is, in other words, not a disease but a normal feature of aging. A little further research, all into readily available sources, revealed that routine bone scanning had been heavily promoted and even subsidized by the drug’s manufacturer. Worse, the favored medication at the time of my diagnosis has turned out to cause some of the very problems it was supposed to prevent—bone degeneration and fractures. A cynic might conclude that preventive medicine exists to transform people into raw material for a profit-hungry medical-industrial complex.

I give credit to Ehrenreich making a conscious decision to pursue quality of life on her terms, and that she regards obsessing over improving her health as a time-waster and potentially counterproductive.

I have to confess to being a bit of a health obsessive, but not the sort that seeks out or much likes the medicalized version. I came to it by being a fat child and harassed pretty badly for that every time we moved (way too often), which resulted in my dieting in my teens and over a period of years getting to be thin and becoming obsessed about never being fat again. That’s meant ongoing undereating (the NIH should be paying me since I am doing the human version of what heretofore has been animal experiments) as well as pretty relentless dedication to exercise, which has been a mixed bag by virtue of my not having the alignment or the joints that are well adapted to regular, intense exercise. Even though I am sure I have gotten a lot of general health benefits, it has come at the expense of knee and hip injuries that have become an ongoing problem.

One of my rationales for how I operate is that I don’t expect my habits to extend my life but to improve the quality of life that I have….but orthopedic problems at my age would seem to say I’ve been kidding myself.

But one thing I do have in common with Ehrenreich is saying no to many tests. For instance, I recently annoyed my orthopedist for not getting an MRI for my hip. What was the point? I am pretty sure I have a labrum tear from a bad fall and the resulting new symptoms. It turns out I have some underlying arthritis. The only option besides physical therapy or a hip replacement (which I am not getting, I can live with what I have) is arthroscopic surgery…which only has a 50% success rate if that, and the success rates are poor with patients that already have arthritis. So since I’m not willing to pursue surgery, what is the point of more diagnosis (particularly since my past experience with MRIs was that they didn’t produce conclusive results)?

But the orthopedists (not mine, thank God, but you can see the scare-talk messaging on line big time), is if you have a hip injury and don’t get it operated on pronto, you will get arthritis. My physical therapist/trainer says that’s false if you keep the posterior chain (buttocks, hamstring, calves) strong and decompress the joints. In other words, if you do physical-therapy informed exercise, you can at least make sure the injury doesn’t progress.

I refuse to get an EKG despite my MD pushing it (she’s finally given up) because I am in a vey low heart attack risk category and it is clearly not warranted. I’ve refused to get a colonoscopy. The US is the only advanced economy that recommends them for everyone; the normal standard is to encourage them only for those deemed to be high risk, with different medical systems drawing the line somewhat differently. In fact, a vastly cheaper and way less invasive test, a fecal occult blood test, has virtually as good a track record as colonoscopies at detecting colon cancers for people not in high risk groups….but you do need to get them every year if you plan to ditch a colonoscopy.

I am sure some readers will pipe up and point out that the vaunted annual checkup isn’t necessary. But if you are on any sort of medication, in most states, by law, a doctor Rx is good for only a year, which means you have to come in every year whether you really need to or not.

I’m curious to get reader reactions. The reason for the personal narrative is I am a bit of a health neurotic, yet I’m also a bit leery of modern medicine, due to its tendency to overprescribe and be overconfident in the efficacy of its interventions. The “normal” people who overshared test results and FitBit readings seemed like a caricature. But then again, the press is full of stories about things like “nutritionally dense” foods, “biohacks,” and anti-aging tips whichfit squarely with Ehrenreich’s sightings of medical obsessives. So it may be sample bias, that I don’t have enough truck with the affluenza who are the big consumers of life extension techniques, both medical and non-conventional.

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  1. A. I.

    Over the last decade the USPSTF has revised many of their screening protocols which leads to less stringent testing. Various specialty organizations have not followed suit so health screening remains a mashup of protocols. Your conclusion tends to be correct that much of our medical intervention is superfluous and often gives false positive results that leads to even more costly intervention. Ehrenreich relates a story of a 100 year old receiving a screening mammogram. I know of no physician who would advocate that and Medicare certainly would not pay for it. Breast cancer screening stops at age 75 max. I think everyone should read the USPSTF recommendations for health screening. They are accessible and based on solid scientific evidence uncolored with commercial interests.

    1. Adrienne


      Along with everything else, patients now have to “educate themselves” about the current screening recommendations. There is no incentive for physicians and hospitals to under-screen and under-treat.

      1. Adrienne

        U.S. Preventive Services Task Force

        “The U.S. Preventive Services Task Force is an independent, volunteer panel of national experts in disease prevention and evidence-based medicine. The Task Force works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services.”

        1. Synoia

          I though it was “United States Pushing Syria Too Far”

          Oh dear, dementia strikes again.

          1. Tony Wright

            No, that was US “fixing” the Middle East by invading Iraq, then walking away from the mess they created/exacerbated.
            Result? Hundreds of thousands of violent deaths, several trillion dollars of increased US Federal debt, ISIS, mass destruction, increased Russian presence, millions of distressed refugees…..
            And nobody has even suggested that Dubya, Dick and Don be even jailed, let alone the more mediaeval punishments that they deserve.
            Just another modern miracle I suppose

    2. beth

      “They are based on solid scientific evidence uncolored with commercial interests.”

      My question for you is ‘Has each physician on the panel signed that they do not accept money from a pharmaceutical company?’
      So few medical researchers or physicians get all sorts of payments from companies in the industry.

  2. Mark

    Publicly available “health recommendations” are generally quite poor. Even the the science of nutrition is very poorly researched and understood. We have good through decades of medical recommendations and reversals. The ‘science’ is lousy and is normally heavily influenced by western dietary norms rather than recognition of the diversity of diets and the ability of the human body to grow and adapt. What is abundantly clear though is the dangers of overconsumption of food and most notably sedentary lifestyles.

    We live in a consumption society and plenty of focus is thus put on health products that can be sold to consumers guilted into needing them. I think that goes a long way into explaining to social and media focus on health.

    Personally, my recreation is outdoor adventure sports, specifically rock climbing. To a large degree the culture and attitudes around the sport (and others like it) shun most of these societal notions of how to be “healthy”. Eat and drink to you bodies needs and stay active. Myself and my peers are very fit and healthy but I don’t see anybody talking about it as described in the article. Oh and for those unaware it isn’t just a sport for the young. Seeing people climb into their 60s and 70s is not uncommon.

    My point is that there are large sections of society both in developed and developing countries that are very fit and healthy that don’t have a focus on health like what is now being marketed to us.

    1. Whip

      I’ve found some excellent nutritional advice from the books Nourishing Traditions (Fallon) and Nutrition and Physical Degeneration by Price. Both look to native people for examples of how to eat well as well as citing various non-corrupted academic research. Price’s book goes in-depth into how terribly the civilized diet (white flour, sugar, etc) damages people, especially children with lots of pictures comparing natives on a native diet with natives on a civilized diet, or civilized people on their own diet. Price was a dentist who successfully used food recommendations to help patients stop having cavities in the 30s. His book is no-kidding life changing.

      1. Yves Smith Post author

        I have to tell you, medicine is a medieval art and nutrition has even less evidence and support than mainstream medicine. “Findings’ are regularly touted on utterly crap, methodologically invalid studies, even more so than elsewhere. Why? There is nothing patentable in the food area, hence no money to fund proper research. And that’s before you get to the fact that any studies would have to be done on large samples (due to dropout and non-compliance) over very long periods of time to conclude anything, which means the studies would be super costly.

        I have followed what passes for advice in the nutrition arena for nearly 30 years. It’s fad driven. I would not put any faith in nutrition advice, beyond “avoid processed foods, limit how much red meat you eat, eat more fruit and veggies and keep your portion sizes smaller than American norms.”

        1. PlutoniumKun

          This is indeed something thats shocked over the years – just how little the medical establishment understands about nutrition and health overall. I grew up in a family where my father had a heart attack in 1971 and as a result I was condemned as part of the family to eating trans fat laden margarine rather than good nutritious Irish butter due to the junk science that was peddled at the time. My poor mother actually thought she was protecting us.

          Over the years I’ve looked at how weak, contradictory, and devoid of proper science most nutrition advice has been. Books and books could be written on the reasons for this – a complex mix of epistemic failure within science, corporate interference, numerous interest groups, and just plain incompetence.

          There is some very interesting science out there – fascinating things coming out of research on gut bacteria, the importance of some micronutrients, on the benefits of fasting and time restricted diets, etc (I’d recommend looking up Rhonda Patrick and her Foundmyfitness website for a deep dive into this stuff). But it all comes back I think to Michael Pollens sage advice ‘eat plants’.

          1. Tom

            I don’t think this is shocking. The relationship between diet and health outcomes(*) is extremely complex but science has to isolate variables. Even when it manages to isolate a cause and an effect, it can be hard to turn that into general advice.

            (*) this isn’t even a sensible framing, since a given diet can be bad for one person and good for another.

            1. PlutoniumKun

              Science doesn’t ‘have’ to isolate variables, good science sometimes means accepting that complex systems require study as an entity. Ecologists have long recognised that an ecosystem is more than the sum of the species within it and have developed complex tools to model these systems. An excessively reductionist approach to science can lead to significant errors.

              And while I agree with you that the science of nutrition and health is complex, this doesn’t explain why, for example, it took decades for the health impacts of refined sugar to be recognised by the medical establishment. The data was there for a long time, but was not just overlooked, those who questioned the orthodoxy were actively sidelined.

        2. rd

          Michael Pollan’s advice on nutrition:

          Pollan says everything he’s learned about food and health can be summed up in seven words: “Eat food, not too much, mostly plants.”

          Probably the first two words are most important. “Eat food” means to eat real food — vegetables, fruits, whole grains, and, yes, fish and meat — and to avoid what Pollan calls “edible food-like substances.”

          Here’s how:

          1. Don’t eat anything your great grandmother wouldn’t recognize as food. “When you pick up that box of portable yogurt tubes, or eat something with 15 ingredients you can’t pronounce, ask yourself, “What are those things doing there?” Pollan says.

          2. Don’t eat anything with more than five ingredients, or ingredients you can’t pronounce.

          3. Stay out of the middle of the supermarket; shop on the perimeter of the store. Real food tends to be on the outer edge of the store near the loading docks, where it can be replaced with fresh foods when it goes bad.

          4. Don’t eat anything that won’t eventually rot. “There are exceptions — honey — but as a rule, things like Twinkies that never go bad aren’t food,” Pollan says.

          5. It is not just what you eat but how you eat. “Always leave the table a little hungry,” Pollan says. “Many cultures have rules that you stop eating before you are full. In Japan, they say eat until you are four-fifths full. Islamic culture has a similar rule, and in German culture they say, ‘Tie off the sack before it’s full.'”

          6. Families traditionally ate together, around a table and not a TV, at regular meal times. It’s a good tradition. Enjoy meals with the people you love. “Remember when eating between meals felt wrong?” Pollan asks.

          7. Don’t buy food where you buy your gasoline. In the U.S., 20% of food is eaten in the car.

          1. Skeptic

            Some of Barbara Ehrenreich’s push back is against this sort of one size fits all “rules” set out by “experts”. Read, live,experience and reflect and come up with what what works for you. Just because it works for a celebrity or someone whose occupation is to cook and review foods doesn’t mean its going to work for you and your schedule. Acceptance and tolerance is a large part of what Barbara is advocating.

    2. cocomaan

      I remember reading about an easy mortality test that I am pretty sure few doctors do.

      Tell the patient to lie on the floor.

      Ask the patient to get up to standing.

      Watch what happens.

      There are many people I know who are in their middle age who would have serious trouble with this test. My wife and I sleep on a mat on the floor and don’t have a bed, so I do this every morning, but for many people, it’s not something they ever do. But I’ll tell you what – if someone can’t climb off the floor, they probably have serious problems that will become clear very fast.

        1. Yves Smith Post author

          I could never have done this. If you can’t get into a squat, and I can’t thanks to my extremely tight Achilles tendons, you can’t get up without using your arms.

          1. rd

            My personal test for myself (almost 60) is getting into a kneeling position on one knee but then be able to get into a standing position without any additional assistance from my arms.

            Turkish getups (with or without weight) are a great exercise. Notice that a hand/elbow is used to get into a kneeling position on one knee. I prefer a kettlebell to a dumbell when using a weight as it is easier and safer to hold.

      1. Spring Texan

        It’s not great if you can’t get up off the floor, but I guarantee you that MANY people over 60 cannot, and yet they are still enjoying life and living many years. So not buying “serious problems that will become clear very fast.”

    1. Janet Zampieri

      I avoid medical doctors and occasionally sees a naturopath and get blood tests. I am 61 and quite healthy except for a slight hypothyroid condition, which I take natural thyroid to keep in check. The best prevention is to eat lots of vegetables and fruits, stay away from processed food, and eat healthy fats and animal products. The only fish I eat is wild Alaskan salmon.

  3. PlutoniumKun

    From the other side of the Atlantic, i find it astonishing how hard testing is pushed in the US. Although (probably due to health industry pressure), there is constant agitation in most European countries to expand testing, in most cases the medical establishment has resisted it unless it is undeniably justified by sound research.

    On the subject of mammographs, I remember listening here in Ireland to a senior oncologist on the radio accuse an epidemiologist of sexism and misogyny for not supporting a call for mammographs for all women. I asked a family member, a medical researcher about the conversation (I know full well that research only recommends mammographs for older women and those at specific high risk). He just sighed and said ‘just because you are a very good doctor, doesn’t mean you understand statistics’. Apparently this oncologist was notorious for a self righteous view on the topic, and colleagues had essentially given up on trying to persuade her otherwise. But as journalists would say, she was ‘good copy’.

    On a personal level, I’m a bit of a health obsessive too. I have ongoing joint problems because of my habit of falling off my bike a lot. I tend to read health research a little obsessively (mostly out of nerdiness), and I learn a lot from the various medics in my family. I’m currently trying to lose a lot of weight as I’m tired of not fitting into my cycling kit when the spring rides come about.

    But the essential point I think that comes out is that while its good to go regularly to a doc to check out any ongoing issues, especially those that may be an early sign of cancer, most testing is either useless or counter productive. We know how to be healthy. Exercise lots, aerobic, anaerobic and resistance work. Avoid processed foods. Eat lots and lots of plants, especially those dark green or bright reds. Don’t smoke or drink too much. Everything else is just luck or genes.

    1. Carla

      Preventative tests make money, and that’s all you need to know.

      As far this side of the Atlantic goes, it’s evident that the business model of American medicine is broken. Proof positive in today’s links:

      The most broken part is, it never should have been a business model in the first place.

  4. Tomonthebeach

    If you did not eat right and exercise regularly, smoked, drank too much – too often, abused drugs, etc., at 65 it is too late to reverse the damage to your genome.

    I often remind my Boomer peers that whatever you were going to be when you grew up, you’re it. Similarly, whatever vitality and longevity you will enjoy as you enter the final stage of human life is entirely contingent on how you lived your adult life.

    Assertions that 75 is the new 65, and that Big Pharma will extend your vitality is delusional. Obsessing about the effect of decades of poor life choices is neurotic self-indulgence. There is no corporal absolution for adult sins regardless of the intensity of our current acts of penance – redemption only applies to the soul.

    Regardless of such facts of old age, many well-to-do people will waste their dwindling supply of vitality on excessive dieting and exercise. Me? I’m grabbing my towel and headed for another day of fun on the beach. I paid my dues when it mattered.

    1. Tony Wright

      Not quite such a good idea if like me you are a ‘ranga’ and live in the southern hemisphere where the ozone layer still has not recovered from the ravages of CFCs during the late 20th century. Hence a melanoma surgically removed a decade ago following its rapid discovery on my upper back by my wife, who is a very competent, and luckily for me very observant , veterinary surgeon.
      As for the preventive health debate, I used to work in Public Health ( in my case the prevention of vector borne diseases such as RRV), and the disparity in political interest, and hence funding levels, between Public Health and curative medicine was extreme. Part of collective human psychology seems to be willing to spend buckets of money on fixing problems once they arrive, but extreme unwillingness to spend on preventive measures even when causality is as obvious as the nose on your face.
      So now at 65 my mantra is “use it or lose it” – I climb our local 1100m rainforest covered ( and therefore shaded – no more melanomas) mountain as fast as I can once a fortnight, and do a Pilates class once a week. I also cook mostly from scratch – none of that packet s…, and just for balance?(sanity in a mad world?) I still smoke ganja 45 years on.
      Life is a perfect imperfection ( apologies to the late Lowell George)

    2. Carla

      “whatever vitality and longevity you will enjoy as you enter the final stage of human life is entirely contingent on how you lived your adult life.”

      I disagree. I think our vitality and longevity can be at least equally chalked up to which parents we happened to pick. Not fair at all, but there you have it.

      1. kareninca

        I agree with you, Carla. From what I see, genes are a huge factor. I know plenty of people with good genes who lived badly who are doing fine, and plenty of people who have done their best and are doing badly. Saying that it is all “entirely contingent” on how you lived, is just blaming the victim in many cases.

        1. Tony Wright

          For example Keith Richards. It is a source of some ,no doubt dubious , comfort to me that I was born in the same town as he was. That town( Dartford) is located right next to the Thames tunnel of the same name. Every day there is a queue miles long of diesel fume belching trucks waiting to pay the tunnel toll.
          I am very glad that like ‘Keef’ I left Dartford long ago.
          My mother tells me that when I was born London smogs were so bad that you could not see a metre in front of yourself.
          So, I agree, genetics has a lot to do with it. So has modern medicine – many people are alive today only because they or their anticedents were prevented from death by modern medicine.
          But perhaps that is a moral/ philosophical debate for another day? i.e. Humanity via modern medicine which enables individual survival but diminishes the gene pool, vs a more Darwinian survival of the fittest/ maintain the quality of the gene pool approach.
          Disclosure: I was yanked out by forceps at birth, so would probably have died at birth without medical intervention. A moral dilemma indeed.

          1. rd

            About 10 years ago or so, somebody was interviewing an actuary and they were going over likely remaining years for some well known figures based on publicly available information. When they got to Keith Richards, the actuary just said “He died 20 years ago. There is no explanation for why he is still around.”

      2. Spring Texan

        I think our vitality and longevity are not mostly chalked up to either our personal behaviors (although certainly you can WRECK your health with certain behaviors like alcoholism) nor to our parents, but rather to how favorable our environment was. Was good food available, did you have a decent job and decent housing and good security and clean air and clean water and access to libraries and education? Were you treated with respect or reviled? Did you live in peace or war? Was your personal environment harmonious? That’s the real determinant.

        If it were mostly our parents, lifespan wouldn’t have increased as much as it has.

        But definitely if we had fortunate and caring parents, we too may have had a better environment through our own lives. But it ain’t the genes (although again, if you inherit something terrible, like Huntington’s, genes can wreck your health).

        1. kareninca

          Well, I’ve “done everything right” health-wise and have had every advantage (food, housing, security, air, water, education, respect, peace), and I’m still developing every crappy thing that runs in my family. I agree that someone who has had disadvantages would have it much worse.

        2. beth

          I agree, Spring.

          Last week I was discussing how badly my thyroid is off by telling her my current diet(no other sugars) as I am gaining a pound a week. She chastised me for sometimes eating 3 fruits in a day. We are way, way crazy about the eat in this country. I think the MSM is not helpful in the least.

        3. rd

          Its actually a key reason why I live in upstate NY. I could make more money living in one of the big cities, but we just did not want to live in air pollution, long commutes in heavy traffic, financial stress due to high housing costs etc.

          Lots of family issues in my genes (mainly cardio-vascular and diabetes) but reducing environmental stresses is likely to be long-term beneficial.

    3. a different chris

      >If you did not eat right and exercise regularly, smoked, drank too much – too often, abused drugs, etc., at 65 it is too late to reverse the damage to your genome.

      I appreciate your fervor, but apparently, no. I align with our gracious host who, if I read correctly, is staying in shape and eating well to feel good during what time she has, not because she expects it to make a real difference in years. I only offer the below in my defense, an excerpt from the Wiki of the woman who outlived everybody:

      Her husband introduced her to smoking, offering cigarettes after a meal, but it was not her passion. (“After the meal, after just one, I’d had enough of it”.)[9] Calment smoked cigarettes from the age of 21 (1896) to 117 (1992).[1][9] According to one source, she smoked no more than two cigarettes per day and it is not known whether she inhaled,[23] whereas an earlier medical source states that she smoked cigars with her husband before changing to cigarettes more recently.[7]

      She and her husband sometimes travelled to nearby Marseilles where, at the Phocéen restaurant, they treated themselves to seafood, a glass of white wine, and bread and butter. Unlike her husband she did not enjoy pastries, but she did like creams (crèmes), cakes and in particular quatre-quarts (pound cake), and vanilla ice cream,

  5. Tinky

    When I was a child (in the ’60s), I noticed that most “old” people had poor posture, and did not move well. When I encountered anomalies, I was fascinated, and made a conscious decision to somehow emulate them.

    In Junior High School (as a 13/14yo), I experienced knee pain, and my well-meaning mother took me to a highly regarded orthopaedic doctor who happened to be the official doctor of the Northwestern University football team. He correctly diagnosed the problem as Osgood-Schlatter disease, a common cause of knee pain in growing adolescents (as I later learned). This “disease” is simply a condition that occurs when a child hits a growth spurt, and the bones grow faster than the surrounding soft tissue, causing friction and discomfort.

    So, what was the doctor’s prescription? Cortisone shots in my knees! Now, not only was I not Bjorn Borg attempting to get through the finals at Wimbledon, but, as I later learned from a good doctor, the sensible solution was simply to restrict sports activities while the pain was present, as I would (and did) soon grow out of the condition.

    This experienced vaulted me onto an alternative health care path, for which, ironically, I have the horrible orthopaedic doctor to thank. I have eaten well, though not obsessively, and exercised intelligently as well. I have undertaken serious massage therapy (e.g. Rolfing), and stretch habitually.

    I am now 60, and have never had a remotely serious illness. I have seen doctors only a small handful of times, and have only taken antibiotics once (as a lyme disease prophylactic). I have no pain in any joints, nor back pain, and regularly walk, run, and climb as if I were in my 40s.

    I am not suggesting that it is easy to maintain a high level of health, nor that there isn’t a genetic component. But taking responsibility for one’s health can be a highly beneficial step, and has certainly worked very well in my case.

    1. JohnM

      “only taken antibiotics once (as a lyme disease prophylactic)”

      I have heard this from so many people i have to comment. I live on a farm and get at least 20 tick bites every year. Not just a tick found crawling over my skin, but embedded and requiring removal. If i went to the doc for a prophylactic antibiotic i’d be getting one every couple weeks during the summer. I’ve had a tick disease (ehrlichiosis) so i’m not dismissing the risk, just the use of antibiotics without symptoms. Here, in my opinion, is a better approach: wait 7-10 days and monitor yourself for fever and flu-like symptoms. If you experience these, then go and get your prescription.

      I’m no expert but it’s my understanding, and experience, that a tick removed with 48 hours is unlikely to transmit lymes.

      1. barefoot charley

        My experience is the same. I pick ticks off regularly, so regularly that I now usually feel them creepy-crawling before they sink in, but not always by any means. I got lyme disease some years ago, and took the 30-day run of antibiotics. It worked. I never thought of getting shot up prophylacticly, and have experienced no reason to. Peoples’ trained terror of ticks and tick bites, on the other hand, does disturb me. It’s another profound alienation from nature, which is much more fulfilling naked than armored.

      2. Tinky

        First, when I said “prophylactic”, I meant after having been bitten, not before.

        95% of confirmed Lyme disease cases were reported from 14 states, so being bitten by a tick in one of those states is clearly higher risk as there are a greater number of infected ticks.

        I am also under the impression that the problem has grown considerably in recent years.

        I knew someone who suffered from lyme disease, and the results were both serious and very sad. So, given my low exposure to antibiotics, I’d say that it was a reasonable response under the circumstances.

      3. cocomaan

        I’ve also seen the bit about ticks not transmitting lyme for 24-48 hours.

        The best thing you can do for ticks is check yourself in the mirror every night after you go outside from about April – July in the lyme disease regions. You’ll find the ticks.

      4. Brooklin Bridge

        Different people have different reactions to the more virulent tick borne diseases such as Lyme. You may be one of the lucky ones, but regardless, your personal experience on the farm can not be generalized. It is only fairly recently that the complexity and variety of tick related diseases has been more fully researched. The effects can be extremely serious and long lasting (lifetime) and there is no way currently to tell who will be affected (and how badly) and who won’t.

        Diagnosis and treatments seems to be getting better as well as awareness in general (in my neck of the woods, New England, at least), but it is still quite possible to hit a doctor who won’t even prescribe a test for tick borne disease, never mind one who is capable of prescribing an appropriate treatment for the specific case – nor is it an easy thing to do. It’s a complex subject, but the issue with antibiotics and over usage (particularly live-stock) is part of it as is simple and unfortunately frequent incompetence on the subject – and all of this considerably exacerbated by our crazy capitalist market based health care system.

        People who live in tick infested areas should take the time to research the subject, particularly for children, but almost equally for adults. If they get such a disease, they should do extensive research as often it will indicate better choices than the medical advice they get. The diseases are multiple and can be compound. One doesn’t get immunity by exposure. Most of all, untreated, just one of the diseases can be really nasty stuff affecting one for the rest of their lives.

        1. Brooklin Bridge

          And BTW, The 48 hour ‘safe period’ in which to get a tick off, is limited in usefulness. Typically, one doesn’t even feel the tick embedding itself and only notices it much later, as in a few days. Not knowing when it first attached itself, how can one determine if it hasn’t already been there for 48 hrs or more?

          A practical approach is when in an area where ticks have been reported, or where one sees them or even thinks they are around, one should (besides checking themselves and children nightly) be on the lookout for early symptoms which include, ” fever, chills, headache, fatigue, muscle and joint pain, and swollen lymph nodes.” These usually come a week or more after the event. Again, even a few minutes of the simplest research is very worth while:

          Don’t count on seeing a rash (the bulls eye for instance), it doesn’t always occur, but can be a real help when it does. My son got the disease as an infant and we only noticed it at all because of the bulls-eye. The tick had been removed without much thought and then forgotten about. Either that, or it just fell or was brushed off. He was treated in time and has had no known or obvious issues.

    2. a different chris


      Ha, my wife was just growing out of exactly that when I met her. Haven’t heard that word for a long time…

    3. Barry

      Did you go to New Trier High School in Winnetka. I did and am 61 I might know that Orthapefic Doctor.

      1. Tinky

        Hi Barry,

        I went to ETHS. I can’t recall his name at the moment, but he worked out of Evanston Hospital.

  6. James Graham

    “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.”

    She’s being a bit of a phony here. If one likes tasty carbohydrates (well-made bread, pasta, roasted potatoes, orange juice, etc.) then following her regime requires strict discipline. I am doing that but I don’t kid myself. I did it because I’ve learned what is healthy and because I’d like to live as long as possible.

    Also, I see a dermatologist every three months and have had scores of actinic keratoses removed. Not doing that is stupid and dangerous. AKs are pre-cancerous, leading to a form of skin cancer (squamous cell carcinoma) that can kill.

    I will not read her book.

    1. jrs

      We don’t know what her diet is, but neither do we know that it requires much discipline to stick to it, some people can easily maintain a healthy (not model thin) weight sticking to a relatively healthy (not obsessively healthy – more of a normal real human dietary pattern like Mediterranean, Asian etc.) diet as long as they exercise, including with weights.

      I don’t agree with her on avoiding all preventive medicine.

      1. Yves Smith Post author

        Agreed she is extreme. Not have dental X-rays? If you’ve had any fillings, they are pretty much necessary. Even though the fillings can also mask decay on X-rays, that’s the only way you can see if decay has started under a filling and give you the opportunity to replace it, rather than wait to get an infection or a toothache and then need a root canal or worse, an extraction.

  7. oh

    Thanks for the link and your valuable comments. I happen to agree with all that you have stated. I’m one of those cynics that believes that the “free” physicals are a way to seek out so called problems so that the medical industry can provide their expensive “solutions”. I always wonder what the next step would be if they found a problem during a physical, e.g. they say that that you have colon cancer after a colonoscopy. Do I really want to submit myself to their “solutions”? Their “solutions” would usually be surgery and chemotherapy, a great money maker for hospitals and pharma. In quite a few cases, there is no real cure but prolonged suffering. The cases you hear about where someone’s beaten cancer are usually anecdotal and may not apply to your condition anyway!

    1. tegnost

      I always wonder what the next step would be if they found a problem during a physical,
      the next step is to check your insurance plan to make sure you’re not on medicaid and which precious metal your insurance plan is sold under so they can estimate how much treatment you will need/s

    2. Off The Street

      If one watches much television around the national news hour, notice the bombardment of medications. How on earth did prior generations survive without the latest pill for whatever ails a person? Oh, that’s right, they seemed to survive just fine in all their relative ignorance. Life spans increase, but at what cost? Outrunning genetics seems like a mug’s game.

      The NC reader cohort seems to have a demographic bulge in the 55-64 bracket. That overlaps with increased advertising through whatever medium, including that newish Facebook vector. There is some received wisdom in just turning off most so-called sources and exercising some common sense.

      [Edit] Proud to have self-performed a Facebook-ectomy some years ago, now watching events unfold to alternating amusement and horror.

      1. RickM

        “There is some received wisdom in just turning off most so-called sources and exercising some common sense.” Born in the middle of the Baby Boom. Stopped watching all televised news during the 1992 presidential campaign and later cut the cable cord. I don’t even know what most of the miserable miscreants in the news sound like. Much better for the mental health. Reading about them is quite sufficient. And in my day job I teach first- and second-year medical students, sprinkling as much useful subversion into my interactions with students as appropriate. Push back in the past few years has been consistent from the 5% who think the Great American Health Care System is the Best in the World. They see none of the health care disparities that stare at them from within a mile of our building and seem to be those who are in it for the money, despite protestations to the contrary.

        As for Barbara Ehrenreich, she has it about 98% correct about preventive care for those with no indicators, and 100% correct about being old enough to die, which is true for everyone. Contrary to what the medical media say, death is not a disease, and most of the interventions pushed by the establishment do not improve outcomes, as measured in longer or healthier lives. For example, medical consumers whose physicians push statins might have lower serum cholesterol levels, but they generally die right along with their age cohort, of something other than complications of atherosclerosis. Still, as pointed out above, the regular visit to a dermatologist is a good idea for those of us who grew up with Hawaiian Tropic; it smells good but has an SPF of about -1000.

        1. Annieb

          I have a serious aversion to taking any pharmaceutical drug that is not absolutely necessary. The side effects may cause problems equally bad as the condition that necessitated the precription.
          For example, some people get leg muscle weakness after taking statins and so stop taking them. I understand that in some cases this muscle weakness ends up permanent.
          Some drugs such as blood pressure reducers cause weight gain. And weight gain as we know causes all kinds of problems. Some people, like me, get highblood pressure when drinking alcohol. Solution, drink less.

          Taking an antidepressant such as Zoloft (SRI) can cause weight gain, which in itself can cause serious depression. Some antidepressants taken by children can cause symptoms leading to depression and suicidal thoughts!
          Doctors know about these side effects but some inexplicably fail to tell patients.

          I do give credence to the philosophy of food as medicine. A subject too extensive to go into here. Also, herbal remedies can be very helpful, specific ones for specific conditions. Much research involved to learn about this subject. But I will offer that I use oil of oregano, taken internally to ward off an infection in the initial stages. It will sometimes lessen the intensity of an infection that is already underway.

          I agree with Ehrenreich, who is slightly older than me, about being old enough to die. I make stabs at increasing my fitness, primarily for vanity and so that I can go hiking, but I have also accepted that at my age the Ole bod is probably not getting any better. Ce la vie!

      2. cocomaan

        Life spans increase, but at what cost?

        Hasn’t the average life span increased not only because of people actually living longer, but because infant mortality has gone down? So the idea of people living much longer is a little incomplete.

  8. fresno dan

    A cynic might conclude that preventive medicine exists to transform people into raw material for a profit-hungry medical-industrial complex.

    Being a proud cynic, but I can’t take credit where it is not due. Cynics are not foisting calumnies upon American health “care”. Study after study has shown the over utilization of health care in the US and the negative consequences to health. The free market supplies potato chips, porn, and self absorption (Facefook) in quantities that are only beneficial to the one selling the stuff. And also with health care, it provides more than is useful, necessary, or yes …..even healthful.

  9. Steve H.

    Sleep, food, exercise, in order of priority. Known since ancient times, though what is ‘good’ gets revised.

    Fasting is in juxtaposition to medicalized health, it is the opposite of a consumer solution. There is a tax on time for every medical interaction, the cash for the visit only disappears if you also consume insurance, and the usual solution is to buy a pill to consume. My pre-diabetes was cured by what I did not do.

  10. Arizona Slim

    Another medical dropout here. I rarely get sick and I avoid doctors like the plague. I attribute much of my good health to public health measures like food safety, clean water, and sanitation. The rest is a combination of diet, exercise, and being a party animal.

    1. Katniss Everdeen

      Another medical dropout here. I rarely get sick and I avoid doctors like the plague.

      Ditto, although I have several friends who more than make up for my lack of “consumption” and then some.

      1. polecat

        I avoid the whole medico/indusrious/complexed … simply because I .. Can’t .. Afford what it has to offer … and will not sign over what little assets I own so some modern-aged bone-through-the-nose, skin painted witch-‘doctor’ reading ‘digital chicken entrials’ from his/her Taj Mahal mud hut … for tests and/or procedures that consign me to cardboard box ‘living’.
        I eat mostly real food, garden as exercise, and try to enjoy the little things in life, like hens and bees …..
        Everything medico related is anymore just psychopathic financialized grift.

  11. The Rev Kev

    ‘If I had known I was going to live this long, I would have taken better care of myself’ – Mae West.
    I think that it all comes down to common sense made more necessary by the fact that so much medical advice is bogus. My supposed BM Index ideal would have me looking like something out of a death march and I find it hard to understand that here we are in the 21st century and the medical profession cannot agree what the average person should eat. And Yves is right – the ideal is quality of life, not quantity of life.
    Just doing flexibility exercises as it seems to be the smart thing to do and some calisthetics as well as aerobic jogging. The annual flu shots I give a miss as I prefer to have my body fight off a flu attack than depend on the fact that they get that year’s shot right (last year they did not). For foods, I am inspired by what Jamie Oliver once said when he noted that when shopping, if the ingredients sound like something out of your grandmother’s pantry, then go for it. If it sounds like it came out of a chemists lab, give it a miss. Go to a doctor when you have to, not when you want to. Question any expert medical advice (we have paid for not doing so). And don’t sweat the small stuff.

  12. witters

    “Sleep, food, exercise, in order of priority. Known since ancient times…”

    The Low Stress Diet.

  13. Jack

    I think you are right to be leery of modern medicine. Our “private” medical care industry is too profit motivated. I agree too a large degree with what you have to say Yves and also Ms. Ehrenreich. But I also think preventative care does serve a useful purpose, if it is carried out in the right way along with living a healthy lifestyle. The VA provides (for me anyway) quality preventative care and in the case of my cancer (which they caught soon enough) excellent treatment. If not for the VA I would be dead. However, I never had the feeling that they tried to do unnecessary tests. And why would they? There is no profit incentive. A good contrast with my health care is my wife’s, which is via private insurance. They constantly want to do tests. An MRI here, another there, even for the most trivial of aches. And all of those tests are horribly expensive. I also would like to add an area that is often overlooked regarding maintaining good health, and that is dental and eye care. Many people do not have access to either. But prevention in each of these areas would do a lot in terms of catching a disease in its early stages and increasing the quality of life.

  14. meadows

    I’m a 65 year old retired married male who hasn’t been to my Dr. in years. Dentist and eye Dr, yes… I am accused regularly of being a typical “in denial” man. I have never had a colonoscopy nor an EKG, blood test or PSA test, all of which my Dr. had recommended years ago. My Dr. had also recommended knee surgery for a torn miniscus (which I never did). I have mild arthritis in hips and knees. He gave up on me and is retired now.

    I walk/hike and bike a lot and don’t get colds or the flu. I’ve never had a flu shot. I eat too much mostly good food, drink too much coffee and enjoy my hard cider (homemade) and a stiff evening drink w/my partner of 45 years. Not a sugar guy or a meat freak. Am somewhat overweight.

    Delusional? Maybe. Happy? Well, it’s in “… the pursuit of….” yes? I’m content enough to call it good as I help care for my almost 3 year old grandson 30 hours a week as he exhausts me. Love is the stuff that heals.

    1. Yves Smith Post author

      I would recommend an eye exam at least every other year. You can easily get glaucoma and not realize it until it is too late, and it’s very easy to treat. My grandfather went blind as a result of glaucoma. I have an investment banker friend (as in plenty of $) who was too busy to get her eyes examined in her 30s, and she lost 90% of her vision in one eye to glaucoma.

    2. Paul P

      I’ve been lucky with tests. My first colonoscopy discovered polys which were clipped.
      Flutter (rapid heart beat) was discovered during a check up and ablated. An aortic aneurysm with an advanced dilation was discovered from an echocardiogram and surgically repaired. Rapid PSA increases led to a biopsy which discovered an agressive
      prostate cancer. I am alive because of testing.

      Fad diets aside, nutrition has led to increased life expectancy and size. An average sized mid-20th Century man would not be able to wear the small sized knight’s armour in the Metropolitan Museum in NYC. And bad nutrition has led to diabetes, heart disease, cancer and obesity.

      Older people have trouble getting off the floor because they eat too much and exercise too little. I am 74 years old. One of my gym exercises is to lie flat and bring myself to a sitting position in a series of repetitions.

      I get periodic eye tests and skin cancer screenings.

      Unnecessary tests are by definition, not necessary. Fad diets are fads. But, good food in moderation and exercise not only make a person feel good, but live better.

  15. Merf56

    Yes of course it is anecdotal but in the space of two days a few weeks ago my 56 year old sister in law was diagnosed with an aggressive breast cancer from a routine mammogram and my older sister, who had a clean colonoscopy 9 years ago, was diagnosed with inoperable stage 4 Colon cancer with mets to the peritoneum and has been given two years max.
    I will, at 61 stick with my yearly mammo( which are much more accurate with much less radiation than even a few years ago) and my every 5 year colonoscopy( as years ago I had a small one of the ‘bad’ kind of polyp.
    As to joints I agree what is the point of testing for testing’s sake once the issue is identified? – I have a slightly bum knee with MRI diagnosed chewy cartledge under my kneecap from too much kneeling while gardening that will lead to arthritis I am told . I exercise by walking as I love it and we are moving back to a year round warmer climate so I can do so this fall.
    I feel Ms Ehrenreich has a perfect right to do as she pleases and makes some excellent points in her essay but at 76 herself my own sister is not too happy about her death sentence as her youngest just married and is hoping to start a family and she still has lots of things she and her husband want to do……
    Mammos and colonoscopies seem to me to be some of the most important and easy tests to get done regularly. Colon prep is even a cinch these days and is not the issue it once was…. I will continue to have both as a I have a lot to live for going forward….

    1. Yves Smith Post author

      I am so sorry about your sister.

      Did you read what I said about mammograms? See this, for instance: and this and this I don’t object to screening for breast or colon cancers. I said mammorgrams are a poor test, even now, and there are better ones in terms of detecting fast-moving cancers early that also do not put radiation into soft tissue.

      And for people who are not in high risk groups, there are tests as good as colonoscopies that are less invasive. The fecal occult blood colon cancer test I pointed out it made annually. Your sister almost certainly would have had her colon cancer diagnosed before it got to Stage 4 had she had that rather than a colonoscopy once a decade.

  16. SD

    This is so interesting to me. I was recently referred to my local health care octopus’s “sleep center” to be fitted with a sleep monitoring device for a home study test for sleep apnea (I am middle aged and overweight and do likely have some mild form of it). I realized as soon as the tubes (inserted nasally) and the monitoring pack (about the size of two decks of cards that is strapped to one’s chest) were adjusted that I would never be able to sleep in the sleep study equipment. Furthermore, the treatment is one of those godforsaken CPAP machines, an even more invasive and cumbersome device that involves wearing a mask attached to a machine that essentially forces air into one’s lungs. I have a good friend who is a physician’s assistant, so I emailed him to tell him my reservations and ask him what he thought about all of this. He told me that sleep apnea has become a trendy diagnosis that is blamed for all kinds of things–metabolic syndrome, narcolepsy, low energy, depression, etc.–that are often more effectively addressed by changes in diet and exercise that result in weight loss. He also told me that the CPAP device itself encourages supine sleeping (sleeping on one’s back), which is the worst position for sleep apnea as it frequently means the head is pushed forward (if it’s resting on a pillow) thus constricting the airway. My PA friend had himself been prescribed a CPAP for sleep apnea, found he couldn’t sleep in it, and used it for about 6 weeks. (A CPAP can cost $1500 or more, needs to be disinfected regularly, and is not returnable if the patient fails to benefit from it.) I returned the sleep study equipment the next day having not used it and told my doctor that I was not going to go down this road. Since then, I have begun eating better and exercising (walking mostly) regularly. I’ve lost weight and my sleep has improved dramatically.

    1. JohnM

      There are options other than the dreaded CPAP to treat apnea (depending on it’s severity) including a number of oral appliances that are much less burdensome to use. Most insurance companies will gladly pay for them since they end up saving money on things like heart attacks.

      I don’t think there is anything trendy about the belief that good sleep is important for good health.

      Oh, and don’t think losing weight is a cure-all for apnea. i have a BMI of 22 but have apnea. Factors such as thickness of the tongue, presence of tonsils, shape of the mouth, etc can pre-dispose someone to apnea.

    2. anon y'mouse

      Losing weight seems to help with most health issues.

      If you can stand it, place a small fan or an air filter on the nightstand near your head. It helped me immensely, but some don’t like to have air blown over them while asleep or they dislike noise. I think It has more of a white noise effect, which might be helpful for sleep as well.

      My other tip is to make sure the bedroom is as dark as possible at night, with blackout shades. Your body really does react to this, and there is a lot more light pollution both outside and inside our homes.

    3. kareninca

      I don’t doubt your experience, but my mom was exhausted all day every day a number of years ago. Then she got diagnosed with sleep apnea, got a CPAP, and has a huge amount more energy. She’s had no trouble with the machine. Recently my brother, who weights 400+ pounds and has not been willing to go for an apnea test, tried using her machine and had his first good night’s sleep in years (he is now considering going to be tested). So it can make a huge difference for some people.

    4. HotFlash

      I’ve lost weight and my sleep has improved dramatically.

      As noted above, that doesn’t work for everyone, but certainly worked for Mr. HotFlash. He did the sleep clinic route, was prescribed a CPAP (fully covered by our Canadian single-payer, as well as all the doc appts and the sleep clinic) and it was hard to say which of us hated it more. For me it was like sleeping next to Darth Vader, “whoooo-haaaaah, whoooo- haaah”, and he may have slept better (we both doubt it) but I sure didn’t. His doctor also recommended that he lose some weight and prescribed, I forget, Lipitor maybe? That was too much, “How about if I just lose weight?” The Doc, “Nobody ever does that.”

      So, despite that, or in spite, he went on the Atkins diet — it just appealed to him. Fats are OK on it, lots of protein and green veg, cut out carbs (sugar, starch) for a couple of weeks, which also cuts out most processed foods, then gradually add them back. He not only experienced a dramatic weight loss, found after a couple of days that his food cravings (chocolate, cookies, ice cream, candy bars, doughnuts) disappeared, he also had more energy and his morning headaches became less frequent and less severe. Bonus! Once he started reintroducing carbs, he found out, holy smokes, he’s got a problem with gluten. So that is gone permanently from his diet now and a bunch of wht seemed to be random symptoms are diminished or gone.

      My local hospital has a poster in all the waiting areas about how We are Partners in Health, that is, them and me. I have found that they have a very narrow definition of my part, it seems to consist of , “Yes, Doctor.” They have called security at least twice on me, once when I made a fuss that the mammogram lady called me by my first name and another time when the receptionist left me sit while she talked on the phone. When I approached her, a trifle out of sorts, after about 45 min she gasped, “I didn’t see you!” I mean, I was the only person in the waiting area! I may have yelled a little bit, but I’d do it again.

      That’s all stuff at our nearest hospital, and I tend to get a little touchy there, as I just keep feeling that I am being dragged into a big machine that wants to process me.

  17. JohnM

    Agree completely about the over-use of mammograms. Heart disease kills 5 times more women than breast cancer. A test exists (coronary calcium scan) to identify those at risk but many people have never heard of it.

    Here is a short video that explains how it’s far superior to other heart disease risk stratification methods. So why isn’t it being pushed on every woman like mammograms? Well it would really put the hurt on the statin industry and the cardiac cath labs.

    1. Katniss Everdeen

      Not to mention the mammogram machine makers like GE, who contribute heavily to “charities” like the Susan G. Komen Foundation, and are financially supportive of “studies” that are instrumental in establishing the current mammogram standards of “care.”

  18. Katniss Everdeen

    “Preventive” medicine makes tremendous sense, but it’s almost impossible to separate its current practice in this country from the “healthcare” profit motive and lousy results. (See today’s link: Goldman Sachs: Curing Patients’ Illnesses Is Bad for Business GritPost (UserFriendly) )

    I’m inclined to agree with Ehrenreich when she says that “preventive medicine exists to transform people into raw material for a profit-hungry medical-industrial complex.” The problem is that you can’t trust a system that subjects so many to unnecessary, often invasive and expensive “preventive” testing and treatment in order to occasionally hit a legitimate home run as it did for Merf56.

    And all that is before you get to the actual “care” that all this “prevention” is intended to justify. From the osteoporosis drugs Ehrenreich mentions, to opioids, stents, cholesterol, low fat dietary recommendations, unsterilizable endoscopes, pelvic mesh and a myriad of other “healthcare innovations” that turn out to be deleterious health hazards just a short time later, at some point, particularly in the absence of serious symptoms, avoidance would seem to be the more prudent course.

  19. Jamie

    My personal philosophy is pretty much the same as Barbara’s, and pretty much for the same reason, i.e. I’m old enough to know I’v started coasting downhill toward an inevitable death, and prolonging my life is not my first priority. My first priority is doing what I can to enrich my daughter’s life while I’m still here, and second, living frugally within my means so that I don’t leave her with a ton of bills to pay and hopefully a little something as an inheritance. I have lived a long and active life and that is going to have to be enough. I don’t eat particularly well, but I don’t eat a lot of junk food either. I eat what I feel I can afford. I don’t exercise very much either. Unlike Barbara, I do not feel good after exercise. I resent the time it takes, how boring it is and the fact that my joints ache for a long time afterward. I walked three miles a few days ago and was in considerable pain for most of the time and a considerable time after. Not fun. But that’s way too much about me.

    What I think is important that needs to be stressed is how, in our current culture (and in this post), “preventive healthcare” means each individual doing personal things with their individual diets and exercise programs, and all living in a sort of hostile relationship to the medical establishment which is also entirely focused on individuals all striving individually to enhance or prolong our individual lives.

    I would like to hold up a different vision of “preventive healthcare”. My vision is one where, as opposed to corporate health systems and medical research designed to make profits, we might have a robust “public health” focus in our medical research and medical academies, which takes real prevention seriously. Such a public health oriented society would re-establish community rec centers and organize physical, mental and social activities geared to keeping people in touch and active throughout their lives. It would tax or otherwise penalize the sale of junk food, and most importantly, make healthy food widely available as an alternative. It would prohibit the abusive marketing of alcohol and tobacco, and regulate job conditions and environmental conditions so that everyone had good clean air to breath, and good clean water to drink and so that labor was not physically or mentally damaging people.

    What I’m trying to say is that living a “healthy lifestyle” is not an individual choice for most people. And it makes little sense to try to live “a healthy lifestyle” individually while living in an unhealthy matrix of atomized lives preyed upon by employers and vendors of unhealthy foods, toxic environments and high-cost medical interventions. “Preventive medicine” is social medicine and social activities in a healthy environment.

    1. Mac na Michomhairle

      You are very right in what you say–so right that I can’t think of anything to add.

      The fact that your suggestions sound a bit odd and utopian is a comment on our society.

    2. jrs

      Your suggestions match the Blue Zone books suggestions. Ok Blue Zones don’t go far enough, a good and healthy society is not and never will be compatible with neoliberal captialism and it needs to be shouted from the rooftops: down with this economic system! In fact sometimes judging from the Blue Zones a healthy life seems incompatible with industrialization itself.

      But despite being way too insufficiently radical to accept the full implications of their own studies, they do focus on many of the social influences on health (are there places to walk, healthy food encouraged etc.) and recognize health is achieved by society not just by isolated individuals.

  20. Gabriel

    This might be a little tangential, but n+1 had a fascinating piece a couple of years ago about how the business model of many magazines relies to a significant extent on scaring affluent middle-class women.

    EVERY TIME A PLANE FLIES OVER NEW YORK, we think, “Oh my God—is it another Atlantic think piece?” We mean, “an Atlantic think piece about women.” The two have become synonymous, and they descend upon their target audience with the regularity and severe abdominal cramping of Seasonale. “Why Women Still Can’t Have It All,” “The End of Men,” “Marry Him!” These are articles intended to terrorize unmarried women, otherwise known as educated straight women in their twenties and thirties, otherwise known as a valuable market, if not for reliable lovers then at least for advertisers.

    Scare medical articles that include “studies have found” might be the equivalent for women in their 40s and 50s.

    Preview here (doesn’t seem to be a way now of getting past the paywall).

  21. Whoa Molly!

    My annual exams at the VA saved my life—at least twice. Once, 10 years ago, it caught a silent, aggressive cancer that would have killed me in 36 months or so.

    Thus, while I agree with much of what Ehrenrich says about over-testing, I still believe in a few essential annual tests.

  22. orangecats

    My niece is a nurse with the VA hospital. She is convinced overscreening is a serious problem. There is always something that shows up if you get enough tests. The chance that something will be missed in an asymptomatic person is less than the possibility of false positives, or the side effects of treatments for benign conditions. If you want to go through chemo and radiation for “precancerous” lesions, as an acquaintance of mine did, go ahead. I think it’s nuts. My then 76 year old mother who has never in her life been screened for anything finally got a chest x-ray. She had COPD symptoms. They found a “cancerous” lesion, very small. She agreed to surgery, then flunked the breathing test. She said, oh well, it’s probably a TB lesion anyway. (She was convinced she had TB as a child.) Fast forward 12 years, the lesion had not grown. At all.

    Doctors don’t keep data on people who refuse treatment. I found this out when my father was about to undergo quadruple bypass surgery in 1983 for angina. I asked his surgeon what happens to people who don’t have bypass in this situation. He had no idea.

    My own rare experiences with the medical industry have been disasters. My first pregnancy resulted in a raging nosocomial infection acquired from unnecessary induced labor. I got screened too much during my 2nd pregnancy. They scared the sh*t out of me claiming the pregnancy might be post mature. I had hired a midwife for a natural birth. I agreed to the cesarean. My son’s gestational age was 39 weeks. I haven’t been screened for anything since 1988. I’m 66.

  23. Kris Alman

    Bravo Barbara Ehrenreich!

    Having briefly worked as an internist for Kaiser Permanente nearly 3 decades ago, I had strong convictions about “preventive” medicine. Physical exams to evaluate blood pressure, skin evaluation, listen for heart murmurs, and to assess for breast lumps and prostate nodules; Pap Smear, cholesterol, mammogram, Flex/Sig or colonoscopy… These exams would uncover early disease and early treatment. What a good feeling if I could motivate a person to stop risky sex, to lose weight and to stop smoking to avoid chronic medications!

    But with the onslaught of more and more testing and metrics that evaluate a doctor for ordering these preventive tests came the two-fold reflex of more tests and drugs.

    More tests means more false positives (PSA) and a general trend for lowering disease threshold. As an activist on access to essential medicines, I was dumbfounded when a woman bantered on about why all boomers should get Hepatitis C screening. Even the CDC has a fact sheet supporting this. At $1000 a pill, Solvaldi would love a piece of that preventive medicine pie!

    The test has taken over the doctor appointment in a fast medicine approach. Fast medicine means you rely on a machine to give a blood pressure and pulse. Missing out on the latter and you miss hints about a person’s well being: the irregular beats, thready or bounding pulses, and so on. The physical exam is a misnomer these days as docs are more likely to be touching the keyboard rather than the patient.

    The fast medicine approach preys upon the neuroses of the worried well who are eternally looking for the fountain of youth. What’s a doc to do? Ply their neuroses with antidepressants and create another PhRMA-induced addiction (because it’s not sufficient with just opioids.)

    What advice do doctors or nutritionists give patients when it comes to our food? After all, the food industry preys upon the worried well. Subject to so many trends (gluten free, Paleo, Atkins, Zone diet, South Beach etc.), how can the health-conscious person experience pleasure eating?

    In the mean time, we drink water out of plastic bottles lined with BPA or some other unhealthy alternative, wreaking havoc on the environment at the same time. At the same time, lead spikes our water supplies and communities insufficiently address this problem.

    I stopped my preventive tests (which were all very normal) a decade ago. I apologized to my primary care physician, knowing my refusal to get these preventive tests would be dinged against her. That includes the mammogram which I had gotten days my husband worked as a radiologist, preventing me from getting a call-back for additional views of my “dense breasts.” KP doesn’t allow that activity anymore. The call-back is a diagnostic, not free “preventive” test, that adds worry, hassle and costs.

    Neuroticism creates ROI in the health care industry for those who can pay. And those who can’t? Well they generally have other reasons to be suffering–which are not solvable through healthcare.

  24. JEHR

    I, too, am on the downhill path of my life being the same age as my mother when she had her heart bypass and five years away from the age of her death. Though, just out of curiosity I often wonder what will finally determine my fate; I have spent some time getting used to the idea of death and it no longer gives me that anxious feeling that it used to. I will try to have a “good” death if I am given the grace to do so. I have also decided that if certain things happen, such as a need for a heart bypass, that I will bypass that surgery based on what my mother went through after hers. I do not want to be hooked up to numerous machines any time in the future.

  25. Lord Koos

    I’m with her, I see a doctor as little as possible. I’ll be 67 this year. They say that once you make it into your 60s, your life expectancy will generally be determined by your genetics. In my case, most of the men in my family have from heart attacks when in their 80s.

  26. freedeomny

    I have had two hip replacements that were unavoidable – I essentially could not walk. Apart from that I rarely go to the doctor. I stopped going for routine mammograms almost 15 years ago and only do self exams now. The reason being is that I decided that even if I did get cancer, I would not follow the traditional medical advice – I believe that sitting in doctors offices getting poked, prodded and injected with chemicals would be too stressful and incredibly harmful to me, given my personality. I have far more faith in my body’s ability to heal itself than I do with the medical establishments understanding of disease. My physician is well aware of my views – and she never tries to push tests on me. I do regularly check my skin for anything that looks odd and have caught basal skin cancer twice.

  27. Jeff N

    I first met Barbara at an NC meetup last year, and we ended up talking for hours that night! I almost missed this article!

  28. Jay Jay

    PSA testing is the most egregious example of overreaching in men’s health. The ratio of false positives is a whopping 12 to 5. Of the “accurate” findings, another 25 to 50 percent of the cancers detected on biopsy are slow growing and harmless, yet all are treated with expensive, painful and debilitating results.

    1. Adrienne

      @Jay Jay, PSA testing, along with a rectal exam, are still the only way to detect prostate cancer in its early stages. My husband never had a PSA test since his PCP thought it was a “lousy” test. An unidentifiable pain two years ago eventually led to a PSA test, biopsy, and bone scan, which showed he had a Gleason 7 tumor in his prostate and “innumerable” metastatic bone lesions. He was 61 at the time. His cancer is now incurable, and goddess willing we will have a few more good years together: but had his PCP done a routine PSA earlier, the cancer would most certainly been detected before it metastasized, and at that point could well have been cured.

      The problem isn’t the screening, it’s the rush to treatment.

      The old adage that men will “die of something else before prostate cancer” is, frankly, bu****t. My father died of aggressive, metastatic prostate cancer when he was 72. There were no treatments available at the time.

      After many years of declining, diagnoses of late-stage prostate cancer are once again on the rise. The USPSTF, until recently, recommended against regular PSA testing–but it had zero urologists on its board. While the connection between declining PSA testing rates and increase in newly diagnosed advanced cancer has not been proven, the testing protocol has now been changed to recommend discussing the test and its implications with your doctor. PSA testing, as poor as it is, saves lives.

      This website is an invaluable source for information on prostate cancer. The article discusses “active surveillance:”

      1. LifelongLib

        It depends. Two of my uncles (dad’s brothers) had prostate cancer but died of something else (one at age 94). So far my dad (age 91) and I (age 61) are free of it. I do have PSA testing every 6 months.

  29. nihil obstet

    My doctor once ordered a bunch of tests for me. I refused a few, but took the rest, and got caught in a maze of tests and more tests. A few false positives ran up time, discomfort, and costs. At the end of it all, the doctor asked, “Don’t you feel like you’re constantly dodging bullets?” I said, “No, I feel like I should have stayed off the firing range.” He said, “Well, now you can have peace of mind.” And I said, “My mind was perfectly peaceful until you started telling me all the things that might be wrong.” I’ve stayed way below the level of testing since then.

  30. Adam Eran

    There’s a lot of investment in one’s own point of view. That quote attributed to Mark Twain–“It’s easier to fool people than to convince them they’ve been fooled”–really applies here.

    That said, I’m an aging vegan, take no meds other than an occasional aspirin, and [knocks wood] stay pretty healthy. Here‘s the guy promoting vegan diets contrasting his outcomes to the meat & potatoes boys. You can take a look at his “stars” to see the impressive results he gets. Not light duty stuff, either.

    Meanwhile, Marcia Angell, a former editor of the New England Journal of Medicine debunks the pseudo-science big Pharma promotes. She says the system of testing is so crooked that she no longer trusts the outcome of any current medical study.

    Example: After praising the FDA and its mission, she says ” there is growing evidence that the Center for Drug Evaluation and Research (CDER, pronounced “cedar”), the part of the [FDA] that regulates prescription drugs, has become the servant of the industry it regulates.”

    …but I’m guessing NC readers are already familiar with regulatory capture.

    1. kareninca

      I was a “health food vegan” (although for ethical reasons) for 19 years, and now I am pre diabetic at age 54. The blood glucose readings that I now get after eating “healthy vegan” meals are terrible. Some people can safely be vegan, but some can’t handle the carbs; it kills off their beta cells. You need to test with a meter to see which you are.

  31. susan the other

    I agree with Ehrenreich. I’m old enough to die. Not that I want to run right out and do it. But I’m now 72 and my joints hurt (but my migraine headaches have gone away!) and my digestion isn’t what it used to be, nor are my taste buds. In any triage situation I’d be the last to be saved, logically. My surgeon told me not to be too overanxious about the possibility of breast cancer (I’m one of those patients in limbo -I do not have cancer but I do have slightly proliferating cells…so the science has come to the intersection of health and disease and backs off a bit – probably the best choice. I’m happy to take my chances and not get every test under the sun.) because my heart would get me first. Meaning at my age cancer would be a slow disease. So anyway, there is some consolidation knowing disease slows down. And half the time now I feel like I am playing defense or swatting flies when I imagine asking my doctor ( like Eisenhower asked his military advisers): What are we going to refrain from doing today?

    1. Oregoncharles

      That’s interesting; my migraines mostly went away, too, though today I had an aura (like a sun dazzle in one eye) and felt sort of miserable for a while. Nothing like before, though.

      For those whose migraines have not gone away, strong coffee and aspirin seem to work about as well as fancy medications – I was tipped off to that by a pharmacist!

  32. bobby Gladd

    Old physician joke:

    Q: “What’s the definition of a ‘well person’?”
    A: “A patient who hasn’t been adequately worked up.”

    See “An Epidemic of ‘Wellness’?

    Personally, “if I’d known I was gonna live this long, I’d have taken better care of myself.”

  33. southern appalachian

    Well I am old enough to die. But I do like being active, so – I suppose I consider that a quality of life sort of thing. So I keep up with the literature, fast every now and again, lift weights and so on. Then again, always liked Hojoki’s Ten Square Foot Hut – which is a leap to say the West has scarce thought about aging. The Indian idea of a forest dweller seems to fit me, so sort of adopting that. Maybe Epicurus, some of the Stoics. But, as I said, and particularly living where I do I shade towards Hojoki.

    Hate to admit this to the NC authors and readership, but I have a very muddied view of things, sometimes following health prescriptions, sometimes trying to eat the foods that have the least environmental impact to produce, sometimes just wanting a cheeseburger. Trending towards the environment.

    Didn’t James Hamblin write something along these lines for the Atlantic a couple of years ago? Might have come out in close proximity to the passage of the Affordable Care Act, and I think the general take on it was some young guy was saying old people should die. Which did not quite sound right, and I read the article, and IIRC his arguments were more or less along the lines of Ehrenreich’s.

  34. CanCyn

    My husband’s 86 year old aunt has COPD from a life time of smoking. Like Barbara E , she declared herself ready to die a couple of years ago. She’s been ok health-wise relatively speaking but was recently diagnosed with kidney failure. Much to the chagrin of her medical team, she has refused dialysis and chosen palliative care. I say good for her for choosing her own path.
    I try to eat right (lots of fibre, protein, good fat, some bread/pasta), cook most of my food myself, exercise and avoid the busy consuming lifestyle that seems to come with so much stress. I see my doctor once a while but not annually. Mostly to keep an eye on my back where I had severe sun damage as a teen. I think that in Canada we don’t get pushed into testing quite so aggressively but it is there. My doc is pretty sensible, not pushy and I do fear her retirement. I think my approach is better than all the testing in the world.
    Yves, like you, I am having some joint issues but feel the my overall health from exercise is worth the knee pain. I am 57.
    Last, I wish more folks would write about the crooked medical research industry. Way too many people think that randomized controlled studies are the only way to advance knowledge. Not so when they’re sponsored by big pharma in pursuit of profits. With regard to curing being bad for business, words fail me.

    1. Oregoncharles

      In my experience, glucosamine with Chondroitin is very helpful for wear-and-tear arthritis. My work is very physical and I’m 72, so I rely on it. It’s a nutrient, not a medicine, so pretty safe, too.

      Once when I was buying some, the cashier, a woman in her 20s, told me she takes it, too, because she was a massage therapist and without it her finger joints start clicking – not a good sign.

      1. Yves Smith Post author

        Erm, glucosamine is ineffective:

        The condroitin commonly combined with it is not the compound which was found to be a co-factor. The one that would in theory make a difference is too expensive, so they used another one that has no evidence supporting its use.

        These are better joint supplements:

        1. Oregoncharles

          I’ll try that, the next time my joints get sore (it depends on what I’m doing – mowing for hours was the worst), but I’ve already found turmeric ineffective. Maybe in combination, or with the curcumin concentrated. And I’ll avoid paying for the chondroitin next time.

          I think a big part of the problem is that responses to either medications or supplements are highly individual. That’s certainly true of neurological drugs (drawing an analogy). The purpose of taking glucosamine is to make sure your body isn’t short of it; if there’s no shoirtage, there’d be no effect. (The same is true of tryptophan and some other supplements.)

          Statistics can be misleading in the other direction, too. Even in a properly done study, it only takes a few people responding to provide a statistically significant result, even if most got no benefit. Sorting that bit of signal out of the noise is very difficult.

          Of course, the best is not beating your joints to death, but that isn’t always an available option.

      2. freedeomny

        Tumeric is great for arthritis and inflammation although it takes a while for it to build up in your system. I found it works best if taken with black pepper – you can get both together in capsule form – but I even put raw tumeric root in my breakfast smoothies…

  35. cocomaan

    I got a new doctor out in Amish country last summer when I came down with an unexplained fever and was afraid it was Lyme. There’s a pasture of cows right next to the doctor’s office. They look at you as you go inside.

    They’ve been a dream. A lot of what they do is still on paper. They saw me the same day I called and had me leave with a prescription for a lyme test in case my fever persisted. It didn’t.

    I attacked a firethorn bush in my yard that had gone haywire and had a severe allergic reaction. They gave me some steroids. Didn’t press me for an annual physical. Gave me a tetanus shot on request.

    I’m really liking my new doctor. My last doctor wanted blood work all the time and was clearly fleecing me. I think its the fact that many of their clients are mennonites with little money that makes them easygoing.

    1. Oregoncharles

      Firethorn (pyracantha) is a deeply malevolent bush. One got me in the eye years ago (to be fair, I was trying to cut pieces off it) and I’ve had it in for them every since. When I have to care for one, I cut off everything that points at me. Over time, this produces quite a handsome flat fan effect.

      Off topic, really, but treating those things with deep suspicion is definitely better for your health.

      1. cocomaan

        Glad that someone else knows my pain. Malevolent is the right word! It’s a devilish plant.

        I now have the whole shrub/tree in a pile in a corner of the property was originally going to burn it but I’m afraid that the fumes might have actually killed me judging from my current allergic reaction.

        1. Clive

          Yes, I hacked mine right back late last autumn. It’s on a very short leash. If it gets anywhere near poking distance of the lawn, it’s coming out.

  36. Fred

    You might want to read Dr. H. Gilbert Welch. His book, Overdiagnosed: Making people sick in the pursuit of health,, addresses just what you’re discussing. He has videos on youtube, e.g.,, for those who’d rather hear a talk. He’s not political, but does mention that narrowing the definition of normal blood pressure, glucose, etc. adds thousands of new patients. His discussion on cancers is particularly helpful.

  37. Adrienne

    Great topic, thank you Yves!

    It’s definitely tough to decide what to do, and what not to do, regarding testing and procedures. With the fee-for-service system we have, I don’t feel I can trust clinicians to offer unbiased advice in this area. Like most issues about my own health, I rely heavily on my gut feeling (literally!)

    Screening can definitely save lives. I have a friend who was diagnosed with breast cancer in her 30’s, she is now cancer-free. My mom is cancer-free at age 85 thanks to a skilled manual exam by her physician. My husband was never given a PSA test until his cancer became metastatic. So many stores we can tell about family and friends whose lives have been saved due to early detection of cancer.

    So is there over-treatment? Over-screening? Undoubtedly. Many people don’t have the time or energy to do their own research into the technical recommendations… but one thing we can all do is to listen to our bodies.

    My mom is a good example for me to follow. She’s very leery of medications–she won’t even take NSAIDS if she can avoid it–and monitors her health religiously. She’s 85 and in great health, she even quit smoking two years ago after 60 years. She exercises and eats well, though she’s not ascetic about any of it. “Moderation in all things, including moderation.”

    But when she was diagnosed with breast cancer, she went all in on treatment. She had a colonoscopy last month, even though she really didn’t want to, and had a few benign polyps snipped.

    She expects to live to be 100, and gosh darn it I wouldn’t be the least surprised if she does.


    A bit of woo-woo, just for perspective… after my hubby finished chemo last year, he pulled two cards from his deck of Oblique Strategies cards:

    Question the Heroic Approach

    Ask Your Body

    These two principles have been guiding us ever since.

    1. paul

      It can be quite difficult to ask your body.
      Through an accident of education, I had to undergo a general health test at 18, conducted by a deadbeat quack, hiding in academia.
      He diagnosed a heart murmur and referred me to a consultant.
      While I waited for the referral I became acutely aware of any unusual feelngs, noise became spurious signal.
      I could not tell what my body was saying, if it was speaking at all.
      Fortunately the consultant(one who had the lost skill of the oscilloscope) declared a clean bill of health.

      There was never a problem, but it did teach me how corrosive an idea of a problem can be.

    2. freedeomny

      “So many stores we can tell about family and friends whose lives have been saved due to early detection of cancer.”

      This is one of the issues I have with the medical establishment – how do you know that your family and friends lives were saved because cancer was detected early? Because the medical establishment told you? Maybe that’s really what they want you to believe but since there aren’t any studies to the contrary – we really don’t know if detecting cancer early saves lives. For all we know you could have cancer in your body for years and still live to be 100…..

      1. Merf56

        I’m sorry but that is simply pure unprovable bunkum or pie in the sky thinking. Cancer in general kills. Detected early it can be completely removed/killed in more and more cases as treatments get better and more narrowly targeted.

        1. blennylips

          So, was the “war on cancer” just a “failure” or and “utter failure”? google it up and you decide!

          Cancer is not a single disease. For the definitive biography of cancer, as mentioned several times before here on NC, read:

          The Emperor of All Maladies by Siddhartha Mukherjee

          Many, many hopes dashed on the rocks of reality…

        2. freedeomny

          I am sorry but I disagree. I know two women diagnosed with stage 1 & 2 breast cancer who did “everything” they were told to do by the experts (and one was a nurse!). Their cancers still metastasized to stage 4 and they eventually died. In terms of breast cancer, at least 30% of early stage cancers go onto stage 4 (terminal) even with treatment. At yet, only 10-15% of cancer funding goes to metastatic research….why do you think that is? Do you think that it could be because chemo is big money for the medical industrial complex? Cancer that stays in the breast doesn’t kill – it is only when it spreads to other organs that it does. Which begs the question…why aren’t big pharma, Susan K and all the other “cancer” research/fundraising organizations investing in knowledge re breast cancer metastatic research?

          Please feel free to look up these statistics – they are not on MSM (of course not) but you might want to check out the METavivor site for “real” information on cancer/metastatic information.

          Peace. If you are willing to put your confidence in huge corporations/big money for your health – that they will “save” you – more power to you. I am not.

  38. Mike Mc

    My two cents worth as a 63 year old Type II diabetic guy (diagnosed six years ago and only now taking a pill for it).

    1) I get a full spectrum blood test every six months to keep an eye on A1C levels for the Type II and everything else. Father’s side of family has heart problems (I’m now older than my father and grandfather) so I worried about that for years… mother’s side usually lives into their 90s.

    The blood tests check PSA for prostate issues, various kidney levels (diabetics need to watch these) and my liver enzyme levels. Those approach NAFLD (Non-Alcoholic Fatty Liver Disease) levels yet have caused me no problems since they’ve been at these elevated levels for twenty years, through stretches of drinking daily (a couple of good beers or glasses of wine) and stretches like now where I rarely drink any alcohol.

    The best part of the above is a really good GP who goes over my records with me after the test results come in. It’s quite clear that my blood pressure drops when I weigh less; minding my diet lowers my A1C though not dramatically; my ‘elevated’ liver enzymes are only so when compared to my peers and haven’t risen since the 1990s; my kidneys, heart and prostate all seem fine (thanks Mom!).

    2) Water aerobics for anyone with arthritis issues. Great way to get in better (or good enough) shape so you can move on to additional workouts. I commute 100 miles a day five days a week for work, so the herniated disk and attendant sciatic nerve pains are much more tolerable with water aerobics three times a week. Wife and I will start Pilates (her) and weights (me) in another week or so after about five months in the pool.

    3) I work for the large state university in our small (population-wise) ag state so until retirement in 2020 I have gold-plated health care. No co-pays, low prices on nearly everything – a huge boon when my wife had Stage I uterine cancer a few years ago and had a full hysterectomy.

    We try to balance between making the most of our stellar health insurance and worrying our selves sick. Finding the right GP is critical. Wife’s ‘new’ GP of past two years just noticed she “may have” Hashimoto’s thyroiditis… which she’s had for over five years, all of which was in her charts! She’s found a much better GP but it’s a PITA to have to do this. So even with ‘great’ health insurance our system forces us to be “prosumers” of health care.

    4) I’m a diehard Berniecrat after thirty plus years as a Democrat; now a card-carrying member of the Democratic Socialists of America. The teacher revolts in West Virginia, Kentucky, Oklahoma and elsewhere – plus the 2018 – are making Medicare for All a common topic now. NC readers need to continue educating our friends, relatives and co-workers about this critical subject. It’s time!

    1. Yves Smith Post author

      Sorry, but I have to disagree with your on water aerobics. I tried it many years ago when I got what turns out to be a chronic knee problem and the water aerobics made it worse. Markedly so. I didn’t get relief until my current trainer had a go at it, and it took a while. I needed to make the “back of the chain: (butt, hamstrings, and calves) way stronger than the “front of the chain” (quads) to alleviate very tight hip flexors and so protect my knees. Water aerobics would never do that. They actually made my hip flexors tighter, which is why they aggravated the knee.

      The bigger point is don’t overgeneralize from personal experience. You can recommend that people consider something that worked for you, but don’t present it as a cure all.

      1. Oregoncharles

        Ah. I just suggested water exercise, down below, on the theory it’s easier on the joints. I suppose that’s still a point worth considering, if you can overcome the muscle tightness issues. Anyway, I haven’t tried it, so it’s a very tentative suggestion.

        1. Yves Smith Post author

          No, any kicking in water takes a ton of hip flexor work (psoas) and does not use the glutes much. It’s just about the worst thing I could do. That is why I object strongly to any blanket prescriptions.

  39. Elizabeth Burton

    I had polio at the age of 6, and although I was generally treated well and survived with minimal problems (then), I developed a serious lack of appreciation for “modern medicine” during the recovery and aftermath. This was exacerbated by the birth of four, the process for two of which were dictated by the attending with total disregard for what I might have wanted.

    I last had a regular physician in 1998, when I worked for a health-care provider. At my last “preventive-care exam,” I was informed I had cervical polyps that should be excised immediately. They weren’t. I’m still here.

    I’ve since developed post-polio syndrome, which is pretty much standard because once the disease was “eliminated” in the US it wasn’t considered important to keep track of those who’d had it to see if it was really “cured.” Turns out it wasn’t, but I digress. The issue is that the all but total ignorance modern medical practitioners have about polio and its aftermath can be hazardous to my health. I’ve read multiple horror stories from other survivors of mis-diagnoses of MS and other similar neurological disorders, with treatment for same that had consequences for their health over and above the actual cause.

    For me, the biggest lie responsible for the current situation is that medical knowledge and how our bodies function are such complicated and esoteric subjects we need licensed professionals to explain things. Who then dictate to us what needs to be done based on generic treatment protocols. Nor do I consider it accidental that so many of the medications being used to treat “chronic illness” all apparently require total suppression of the immune system.

    I’ve had two encounters with “health care” in those two decades, one for a stubborn muscle spasm I could have avoided had I paid attention and another for a face-to-blacktop encounter of the sudden kind. Sitting in the trauma room for the latter, nose broken and upper lip cleft, I had a nurse inform me with a worried look that my blood pressure had soared into the stratosphere as if I should be alarmed. Apparently, sudden injury with attendant adrenalin release is no longer supposed to cause an increase in blood pressure.

    But again, I digress. I am basically sedentary for the simple reason the muscles don’t work as they should and my balance is iffy. Since muscle fatigue is an ongoing problem in PPS, I have to be careful not to overdo, because it can take me days to recover. However, I did research and have a regimen of herbals taken to address the issues of tremor and chronic pain, and they do just fine. Most also have additional qualities suitable for someone threescore-and-ten. All of my vitals are within normal range, and with a little help I sleep 8-9 hours soundly.

    I also continue to refine my regimen, as I’m a firm believer that sufficient is better than too much.

    My greatest fear is that something will require me to engage with the health care-less system under conditions where I will be at the mercy of “professionals who know better” what’s needed.

    1. roxan

      The Pros and Cons of mammograms:

      Radiation-Induced Breast Cancer Incidence and Mortality from Digital Mammography Screening: A Modeling Study

      One test I found useful was screening for Hep B & C. Very common in us ‘boomers’ and by the time you feel sick it’s too late. The new treatment, although expensive, works well–and there are many avenues to paying for it. It’s only a blood test, and I think there is even a home-test kit, although who knows if it’s accurate?

  40. kareninca

    Of course you are the best judge of how much hip pain you can tolerate, and whether surgery actually makes any sense at all. One thing, though – I have always been kind of anti-surgery. But by this point I have known a fair number of people who had hip replacement surgery. All of them have been very, very, very happy with the huge reduction in pain, and were very glad they had it done, and wished they had done it earlier. So don’t dismiss it for all time out of hand; it might make sense at some point.

    1. mtnwoman

      I agree, the two surgeries I hear patients wish they had done earlier — having loved the results– are hip replacements and breast reduction surgery.

  41. kareninca

    Ehrenreich is 76. She’s had a good run; her generation is pretty healthy. The people who I know who are around my age (I’m 54) are mostly a mess. The ones who are younger are even more of a mess. I guess her approach is fine for people who are her age whom it suits (it wouldn’t suit my parents, I’m glad to say), but the rest of us are going to have to make some hard decisions at “not ready for death” ages.

    Also I wonder what Ehrenreich will actually do if something comes up that is treatable, even if not easily treatable. I bet she’ll have it treated. Despite what people say, I saw a study (I can’t find it now) that says that that is what they actually do. Despite saying that they wouldn’t. Talk can be cheap (which can be a good thing).

    1. Adrienne


      Ehrenreich is 76. She’s had a good run; her generation is pretty healthy. The people who I know who are around my age (I’m 54) are mostly a mess. The ones who are younger are even more of a mess.

      This is a good observation, something that’s been in the back of my mind for a while. My parents (I’m in my late 50’s) grew up in a completely different world. They had to contend with deadly infectious diseases, but by and large their environment was much cleaner than ours is now. Innumerable new chemical compounds have been developed since WWII, most of which have ended up in our air, water, and soil, and food. I remember my Dad’s “garden shed” full of the nastiest poisons imaginable: ant & termite killer for the foundation, insecticide for the roses, weed n’ feed for the grass we rolled around in as kids.

      Endocrine disruptors, organochlorides, benzene, dioxin, radiation fallout, electromagnetic frequencies, etc. etc. etc. Unless you’re living out in the sticks and growing your own food, no one has any idea what they’re being exposed to on a daily basis.

      I have young grand-nieces that have truly atrocious “lifestyles”–fast food, prepared microwave crap… antibiotics for every little thing… the TV is on 24/7, plus YouTube, plus Mom and Dad’s cellphones. They already have chronic health problems, as small children. I shudder to think of their future. :-(

      1. kareninca

        My neighbor’s sons (17 and 19, more or less) are both on mental meds. Don’t get me wrong; they need them. These mental meds will not be good for their physical health in years to come. So there is that, too.

  42. Pinhead

    I assume almost all readers of NC are well educated. So I find it surprising that nobody mentions the leading cause of premature aging among well educated people, namely retirement. The statistical evidence for this is on a par with that of smoking cigarettes.

    Actually a great deal of statistical evidence is available for many – probably most – of the issues discussed here. Much of it is inconclusive, suggesting an intriguing possibility. Namely that large numbers of individuals, somehow, figure out what works best for themselves.

    1. ambrit

      Snark alert/ Yep. I always feel way better for weeks after a successful bank heist. Now if I could just curtail my gambling habit… /Snark off.
      But wait! I can do both by getting a Masters in Finance and going to work for a bank! I can rob a bank and gamble to my hearts desire! Combine business and pleasure! Oh frabjous day!

  43. paul lauter

    It seems to me that large generalizations in this area are not very helpful. Yes, good eating, sleeping and some regular exercise are. And, yes, Jamie’s vision of social medicine is certainly a desirable goal. So, too, I would say is a loving relationship.
    Meanwhile, however, I think it’s silly not to have an annual check-up–what’s to lose? My urinalysis showed cancer cells floating around; it took a couple of years to locate the source, but that was done and it was eliminated. Follow-up scans for that and another cancer make good sense for me. Likewise an annual PSA. But those tests might not be desirable (or affordable) for someone else.
    Good docs don’t dictate what we do: they propose possible solutions to problems that (my 85 years tell me) do arise. If it doesn’t make sense for you, don’t do it. But also don’t be ill-informed on ideological grounds.

  44. kareninca

    In case it was bladder cancer: (“After adjustment for other prognostic factors, a strong and significant inverse association was observed between bladder cancer mortality and broccoli intake, in particular raw broccoli intake (≥ 1 versus < 1 serving per month; HR for overall death, 0.57; 95% CI, 0.39–0.83; HR for disease-specific death, 0.43; 95% CI, 0.25–0.74). There were no significant associations for total vegetables, total fruits, or other individual cruciferous vegetables.."

  45. Oregoncharles

    “Preventative” medicine is mostly a misnomer; it’s really early diagnosis, which, as Yves says, sometimes helps and sometimes doesn’t. “Prevention” is mostly diet and exercise – appropriate exercise. Yves might want to try swimming or in-water exercise, which is easier on the joints (but that’s just hearsay). Vaccinations and hygiene are also preventive, of course, but those are more of a baseline these days.

    I was grateful for her earlier, umm, warning on colonoscopies. I’ve done the fecal blood test several times since. For one thing, being told that I wouldn’t remember the experience sent up red flags for me.

    OTOH, when I was told my cholesterol and blood sugar were at the warning level, I went on a fairly strict diet to lower them, which did work. Several friends have Type II diabetes (they weren’t a bit impressed with my sugar levels), so I know it’s worth avoiding if I can. I probably should get that checked again, as I’ve backslid quite a bit on my diet. I found the most effective thing was to cut out a couple of items I was consuming quite a bit of: candy, pop (even “natural” ones), and ice cream. I was more concerned about sugar than cholesterol. The only candy I eat is dark chocolate, which has minimal sugar in it. Instead, I eat a lot of dried fruit (home-grown, so pretty cheap); I can eat that and nuts all day with no effect on my blood sugar. It gives my jaws plenty of exercise.

    The diet, when I was strict about it , also lowered my weight about 10 pounds, though I’m not as concerned with that.

  46. UserFriendly

    At 33 I exercise semi regularly just to help with my depression. While I’m not quite suicidal I would be absolutely thrilled if I found out I had something fatal tomorrow and there is zero chance I would try to beat it.

    1. kareninca

      You may end up changing your mind about that. People often become more attached to life as they get older, rather than less attached. Sometimes people age out of depression. In the case of women I’ve seen, it seems to be hormonal. In the case of men, it has been that they have finally found the right relationship. Anyway, you’re so young you should be looking for a ketamine or a magic mushroom clinical trial or something equally cutting edge; really there are a lot of things that can help; even SSRIs are not all bad.

      1. kareninca

        Oh, I see from your post at links that you have tried many things. Even ketamine (I have a relative on ketamine). I’m sorry it is so hard for you. I hope you find something that works. Perhaps a vagus nerve stimulator implant ( It has worked in some very tough cases. Persistence matters a lot here, I know from family experiences.

      2. UserFriendly

        Doubtful. It has been on a steady decline since I can remember. The only reason I don’t just do it myself is the people in my life who would stupidly blame themselves for it.

        1. kareninca

          If you are male I hope that you have looked into testosterone supplementation. I don’t have personal family experience with it, but men’s moods are very much affected by testosterone levels.

          It’s not just that other people would blame themselves, although they would. They would be permanently damaged in ways you can’t picture. Including people whom you wouldn’t expect. So please keep trying.

          1. Yves Smith Post author

            1/3 of the WOMEN who are on anti-depressants have low testosterone and would probably have their depression cured with testosterone supplements.

            1. kareninca

              That is a very good point.
              Userfriendly, if you’re out there, I hope you look into this if you haven’t already. It is not an invasive treatment.

          2. UserFriendly

            Yes, anabolic steroids was one of the billion things I tried, no real noticeable difference.

    2. Anonymous coward

      CBD derived from hemp is legal in every state, and has been known to help with depression and anxiety… about the fatal illness thing, I consider what money I’ve saved to be a hospice fund, rather than a retirement fund.

      I hope you find something other than death that works.

      1. UserFriendly

        Almost all pot makes me more anexious. Only really bad weak pot does anything helpful for me and it is short term.

  47. lowhigh

    On a personal note. I tore the labrum in one of my hips in 2006 (anterior and posterior). An Orthopedic surgeon (a good friend) said not to have surgery (“wasn’t up to snuff yet”) and it would never heal because there were no blood vessels in the vicinity. 3 bouts of physical therapy made it worse. After lots of lessons in the Alexander Technique, I have hiked totally pain-free all over the Alps since then. No, it never healed. I had just learned how to move without placing undue stress on that joint (or any other) and how to use my whole body properly. It might work for you, too. For starters, I suggest reading Missy Vineyard’s book (“How To Stand, How To Move, How To Live”). She’s the head of the Alexander Technique school of New England. It is extremely specific and helpful on what to do, and why. Best of luck!

  48. rivegauche

    I have been avoiding routine tests since 2003 when diagnosed with breast cancer and undergoing biopsies, a lumpectomy, then a bilateral mastectomy and reconstruction. My first reaction after diagnosis was to read everything I could about it.

    The first important revelation was that pesticides used on crops -especially corn- mimic estrogen. And guess what – excess estrogen fuels many breast tumors like mine.

    The second revelation was that chemo wasn’t necessary for tumors like mine where there is no lymph node involvement and radical surgeries are performed. The breast surgeon later told me the same thing. However, the oncologist was extremely miffed that I refused her treatment plan for chemo (3 different chemo drugs), radiation, and tamoxifen afterwards.

    My overall health state in 2003 was bad: 60 + lbs overweight, a diet of processed foods (with some version of corn and wheat and sugars as ingredients in all these foods), no physical activity / exercise. I kept reading and, gradually, changed my lifestyle 180 degrees. Lost about 60 lbs eating real food minus corn products, added fructose and other sugars, and grains, and was walking and running over 5 miles 5-6 days a week between 2007-2010. Never felt better!

    Then, long-term genetic autoimmune diseases flared and caused fatigue and lots of pain. You see, I wrongly thought then that soy was a good food and had worked my way up to a diet that, in the end, included weekly or daily portions of (all organic) soybeans, soy yogurt, soy sausage and burgers, soy milk, and endamame as a snack. Yes, I know now how stupid that diet was. And a wonderful acupuncturist showed the way. Soy is a neurotoxin that, unlike other beans, doesn’t lose the inherent toxicity by soaking and cooking.

    Anyhow, 66 yrs old now and have kept those excess 60 lbs off and still stay active, even if no longer walking and running regularly.

    I came to the same conclusion all those years ago: the medical establishment pushes tests that aren’t necessary and can give false positives or cause injury; and they are eager to get us on prescription drugs that also can be injurious; and lastly, I am old! I am committed to a healthy lifestyle not because of any wish for a longer life, but to enjoy life now.

  49. Timforker

    Ehrenreich’s assertions and self-assessments shouldn’t be the guiding light for the masses. What she is saying is very personal — that she’s ok if death now comes upon her. Nobody (not even death panels stored on Hillary’s secret server) can really say that for anybody. Our environment is a chemical experiment and we don’t really know what dose-responses are for all these compounds. Many many women I know (I am 56) have had breast cancers that was not tied to genetics. I find tests and screenings stressful because I fear illness. But a test doesn’t give you something you don’t have, even if they lead to other tests, which can feel wasteful — unless something is found. Such was the case with a loved one who found an aggressive oncotype breast cancer through a routine mammogram. Thank god, as the treatments were a success (defined by no presence of cancer for years). I will have my “preventive” screening — such as colonoscopy — as long as I can imagine keeping going for the next foreseable future

  50. mtnwoman

    30 year medical professional here… I agree with much of this. However, I do think there are a few things that are dumb to die from since the testing IS good. This includes pap smears and colonoscopies. I have a few beloved patients no longer here because they “knew their body” and “didn’t need” a colonoscopy. Found early, it is very curable and it’s occuring in younger and younger patients. I get that your mileage may vary.

  51. mtnwoman

    This article from The Atlantic a few years back seems appropriate in this discussion:


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