On Cannibals And Cardiologists

Everyone knows that cannibalism was practiced widely in pre-Colombian Mexico. Go online and you will quickly learn that 15,000 to 20,000 Aztecs were sacrificed each year. This “fact” colors our view of that civilization, and makes it a bit easier to give a pass to the conquistadors who, for all their own rapacity, brought “civilization” to the New World and ended cannibalism.

But, it now turns out, this common belief is almost completely wrong, and the larger lesson to be learned can and should be applied broadly. Even cardiologists (and other physicians) can benefit from this lesson, despite the fact that there are no DRG or ICD codes for cannibalism (as far as I know).

In When Montezuma Met Cortés: The True Story of the Meeting That Changed History Matthew Restall explains why the estimates of cannibalism are almost certainly ridiculously overstated. In a review of the book Álvaro Enrigue writes that “most estimates of the frequency of human sacrifices in Tenochtitlan come from an unfounded assertion by the Franciscan friar Diego Valadés, who was born twenty-two years after the city fell.”

Enrique writes that the estimate of 15,000-20,000 sacrifices each year is “preposterous,” since it assumes the Aztecs performed “more than 137 sacrifices a day, five an hour, one every twelve minutes, twenty-four hours a day,” especially since “Aztec sacrifice was a nonmechanized process that demanded extensive ritual preparation and an individually selected victim.” “Archaeologists,” he notes, “have never found evidence to support the Spaniards’ figures.”

How, then, in the absence of solid evidence did such a remarkable myth take hold? Enrique writes:

“Restall shows that while the Aztecs did indeed practice ritual cannibalism, the fixation on the eating of human flesh in the earliest European accounts of Mexico had a mercantile motive: owing to a royal law from 1503, an enemy fighter who practiced cannibalism could be enslaved for life, and shortly before Cortés left Cuba for Mexico a smallpox epidemic caused a drastic reduction in native manual labor in the Caribbean. The later narratives that were so insistent on the subject of cannibalism are always, in Restall’s view, related to the conquistador generation’s claim to cost-free indigenous servitude.”

It needs to be said: we are ALL conquistadors, cardiologists included. The conquistadors may have conquered the new world but they didn’t conquer human nature. A lot has changed since Cortes and Montezuma, but human nature is stubborn, and we can only see things through our own two eyes and with the background of our own self interest.

If you benefit from finding cannibals then you will find more cannibals, and if you benefit from finding and treating heart disease then you will find and treat more heart disease.

The evidence that this effect is present in cardiology is overwhelming. Consider the studies, too numerous to mention here, showing overuse of tests and devices, or the DOJ investigation into the overuse of ICDs. The most publicized cases, like the Mark Midei case in Maryland and similar civil and criminal cases in many other states, represent the tip of the iceberg. They are only the most visible and egregious cases.

Now I know that a lot of cardiologists (and many others) will take offense at being compared to rapacious conquistadors. Of course they are right. No one is accusing cardiologists of genocide. But when it comes to the ability to see the truth beyond our own self interest we are all, alas, just like the conquistadors.


(Wikimedia Commons)


  1. dearieme says

    The great axiom of Economics: incentives matter.

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