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.