How our health system is like the Marvel supervillain Thanos


You are a child of Thanos.

“Hear me and rejoice!”

“You have had the privilege of being saved by the American College of Cardiology and the American Heart Association. (Yeah, I know we said the same thing when we prescribed low-fat diets to decrease the risk of heart disease, but you gotta give us a pass on that one.”)

“Based on our research, we have found 100,000,000 of you are ill.”

“But we can save you, salvation is at hand.”

“With our potions and ministrations, every year we can prevent 156,000 of you from dying from our newly defined disease. And we can keep 340,000 from having heart attacks, strokes, and other related diseases.”

“Of course, some of you will suffer so that others must be saved, so that the universal scales tip toward balance.”

“70,000 of you will pass out and fall at least once.”

“138,000 will have one episode of dangerously low blood pressure.”

“177,000 will have a serious kidney injury.”

“Others will have a variety of other side effects of various degrees of severity. All will have expenses of money and time and the overall risk of contacting the healthcare system.”

“You who have these side effects — side effects you would never have had without being told you needed treatment, you may think this is suffering … but it is salvation. Smile, for even in your suffering you have become children of Thanos (oops) the ACC/AHA.”


Not at all.

These two organizations have redefined the diagnosis of “hypertension” — high blood pressure.

The change is based on a better understanding of the risks and benefits of treating the condition to prevent the bad stuff that comes later.

It’s called “primary prevention,” and it’s a big part of public health. Smoking cessation, cholesterol control, exercise habits — these recommendations have been going on for more than a century.

So, what’s the problem?

What’s different this time?

What’s with the “children of Thanos” stuff?

Thanos, the “Mad Titan” of Marvel’s Infinity Wars, believed the universe was threatened by overpopulation. So, convinced of his righteousness, he used the might of his army to go from planet to planet, killing half the population at random in order for the other half to live.

The population didn’t have a choice. Half died because Thanos was convinced he was right.

With these new blood pressure recommendations, you won’t have a choice either — and neither will your doctor.

Your insurance company is increasingly paying your doctor based on data.

And these blood pressure guidelines are a great example of hard data.

If your blood pressure is not within range, your doctor is going to get dinged. Too many patients with their blood pressure out of kilter, and she’s going to be punished.

First, through public shaming via a reduction in her “STAR rating.” Then financially. Then through her ability to practice at all.

You’ll have no choice.

Take the medicine or find another doctor.

Pretty quick, if you don’t want to take the medicine you won’t be able to find a doctor who’ll take care of you.

Now, I don’t seriously believe the professionals who came up with these guidelines are actually like Thanos. They’re good people, better than me, in fact, selflessly dedicating their talents to help others.

Though they may lack some self-awareness, they’re not really responsible for the misuse their recommendations are going to be put to.

But you, as a consumer of healthcare are going to have to deal with the fallout.

Ten years ago, I wouldn’t have had to write these words.

The guidelines would have come out, and I would have talked with each patient in their turn regarding the individual risks and benefits of additional treatment.

And each would have decided what they wanted to do.

Not anymore.

You have to understand that the health care system is now coercing your clinician to be more interested in treating groups of patients rather than the single one sitting across from them.

It doesn’t matter if you individually might be at a higher risk for side effects, or you’re otherwise at very low risk for heart disease — if your blood pressure numbers aren’t right, even a little, a recommendation for treatment will come your way. Your clinician literally has no choice.

So, you’re going to have to be vocal in your own self-advocacy — and even that may not be enough.

If you can, get your primary care from a clinician outside the system, such as from a direct primary care practice. It’s affordable, impartial, and personalized medical care.

If you can’t, at least learn to recognize the pressures your clinician is under, question their recommendations closely, pick and choose the treatments you’ll accept.

And get used to being fired from your doctor’s practice.

It’s all being done for the greater good.

Tom Davis is a family physician who blogs at Dr. Tom’s Blog.

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