You open your health portal before bed, mostly out of habit, and there it is: a number in red. Or your doctor mentions, almost in passing, that your cholesterol has crept up and your blood sugar is “borderline.” Nothing hurts. You feel the same as last week. But something has shifted, and you know it. You’ve become a person with a problem.
I want to make the case that a red number is not, by itself, a diagnosis, and that the ways to become abnormal have multiplied far faster than the ways to actually be sick.
The doctor who invented patients
In the 1920s, the French writer Jules Romains wrote a play about a country doctor named Knock, who arrives in a village of stubbornly healthy people. For Knock, this is not a public health triumph; it’s a business catastrophe. So he opens a clinic, hangs up frightening anatomical charts, and starts talking. He convinces a man with a small twitch that his spine is deteriorating, and a tired woman that she is a walking time bomb. By the last act, the whole village is in bed, sipping broth and taking its temperature every hour. Knock’s Law: A healthy person is simply a patient who doesn’t yet know it.
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Here’s the part everyone forgets. Knock was a crook. That was the joke; he knew those villagers were fine. If that were our situation, this would be an easy problem: name the villain, avoid the villain, done. But that isn’t what’s happening, and that’s what makes 2026 stranger than 1923.
Today, mostly, there is no Dr. Knock. The cardiologist treating your blood pressure before it causes a stroke is doing good work; so is the endocrinologist catching your blood sugar before it becomes diabetes, the radiologist reading your scan carefully, the lab adding twenty more markers to the panel. In their own lane, nearly all of them are right.
The problem isn’t any one of them. It’s all of them, at once, on you. Each expert optimizes their own corner, and nobody’s actual job is to stand back and add it up. When everyone lowers their threshold to catch their disease a little earlier, the person in the middle quietly collects a stack of labels and wakes up one morning a full-time patient without ever having gotten sick.
I know, because it happened to me. In my late thirties, I fainted while running, ignored it (not my finest hour), and eventually got a proper workup. The conclusion was reassuring: an autonomic quirk, nothing needing a procedure. But along the way we found that I have a large heart. Endurance athletes often do, yet it also sits in the same territory as conditions linked to sudden death. The testing was appropriate. But I went in as a runner and came out as a patient. Years later, it happened again, more quietly: marathons, triathlons, now Ironman, and I feel fine. But my blood pressure, cholesterol, and blood sugar each drifted up a bit, the definitions drifted down, and I collected a second label, metabolic syndrome.
Three reasons it’s harder than ever to be normal
We measure more. Most “normal” ranges are statistical, not biological; normal is roughly the middle 95 percent of a reference population, so about one in twenty healthy people falls outside it by definition. Order enough tests and an abnormal result stops being a signal and becomes arithmetic. In a 1994 study in the New England Journal of Medicine, researchers gave spine MRIs to 98 people with no back pain at all. Fewer than half had a fully normal scan; 52 percent had a bulging disc, findings sitting there quietly the whole time, doing nothing.
We move the goalposts. You can become abnormal because the definition moved, not your body. In 2017, the ACC and AHA lowered the threshold for high blood pressure from 140/90 to 130/80. Overnight, the share of American adults with hypertension jumped from about 32 percent to about 46 percent, roughly 31 million people who went to bed healthy and woke up diagnosed. LDL cholesterol targets have walked down a similar staircase: under 130, then 100, then 70.
This is not a conspiracy. A 2013 review in PLOS Medicine of sixteen guideline publications found the proposed changes widened disease definitions ten times and narrowed them once, and only six of the panels so much as mentioned the possible harms of casting a wider net.
We label more. Fatigue, aches, bloating, poor sleep, brain fog: These are part of being human, and there’s never a shortage of experts with a new name for them. In the 1980s, the explanation was chronic Epstein-Barr, then candida, then Lyme; now it’s mold, toxins, adrenal fatigue, leaky gut. The symptoms are often entirely real. The label is what has to earn its keep: by predicting something, or by changing what you do.
Why a harmless label isn’t harmless
It’s tempting to think an extra diagnosis is, at worst, neutral: more information, no downside. But being labeled has real costs, and they fall into three buckets.
The first is anxiety. A finding you can’t act on doesn’t sit quietly in a chart; it moves in with you. My large heart is exactly this, a fact I now carry around, scanning it for meaning it may not have. Genetic risk results do the same: The brain is physically unchanged the day after the test, but the self-image isn’t. You can spend years bracing for something that was always just a probability.
The second is the cascade. One borderline result rarely ends the conversation; it starts the next test, and the one after that. A scan turns up an incidental spot, so you get a biopsy; the biopsy carries its own risk and may find a second thing needing its own workup. Each step is reasonable alone, but every link adds a small chance of a complication from a procedure you never needed. South Korea makes this visible: As screening ultrasound spread, thyroid cancer diagnoses rose roughly fifteenfold between 1993 and 2011 while deaths stayed flat. Thousands had thyroid surgery for cancers that were never going to hurt them.
The third is cost: money, but also time and attention. Visits, scans, follow-ups, the supplements and subscriptions that parts of the wellness world run on. Slowly, without any single decision that felt wrong, you become a full-time patient, organizing your life around your health rather than living it.
None of this means the original test was a mistake. It means the label has weight, and weight has to be justified.
Four questions
So none of this is an argument against testing. Treating blood pressure prevents strokes, statins help the right people, screening catches dangerous cancers. The goal was never to be under-tested; it’s to be wisely tested, wisely labeled, wisely treated. The next time a value comes back red, a scan turns up a word you have to look up, or a company asks, “Wouldn’t you want to know?” pause and run four questions.
- Is it real? Can it be repeated, and is it genuinely new for me, or one flagged value out of a hundred?
- Is it relevant? Does it explain a symptom I actually have, or did it just fall out of a routine panel?
- Is it risky? What does it change about my odds of a bad outcome, in numbers, not adjectives?
- Is it resolvable? Would knowing change my screening, prevention, or treatment? If not, that’s worth knowing before the test, not after.
Health was never a perfect lab panel, a spotless scan, or a clean genome. It’s the chance to live the life you value, with as much function and as little avoidable suffering as you can manage. Being normal doesn’t mean having no abnormalities. It means knowing which ones matter.
Bobby Dubois is a physician-scientist, podcaster, and multiple-time Ironman triathlete whose career has centered on using scientific evidence to understand what works and what does not in helping patients, and then doing everything in his power to move them down a path toward better health. In recent years he has turned his attention toward guiding others to live longer and with renewed energy as they age, work he shares on his website.
He is board-certified in internal medicine, received his MD from Johns Hopkins, his PhD in health policy from the RAND Corporation, and his undergraduate degree from Harvard College. He worked with managed care for a decade, the electronic health records industry for seven years, and the pharmaceutical industry for ten years, and he guided a D.C.-based think tank.
Dubois has published roughly 180 peer-reviewed articles spanning quality of care measurement, the appropriateness of medical and surgical procedures, comparative effectiveness research, and the value of health care spending, with work appearing in JAMA, the New England Journal of Medicine, Annals of Internal Medicine, Health Affairs, and Value in Health. His podcast, Live Long and Well With Dr. Bobby, focuses on evidence and health and is available on Apple Podcasts and Spotify. He shares updates on Instagram.
