- [Adam] I said that's the problem with statistics
is that they can play into, if they're not framed just right
they can play into the more fearful parts.
- [Mike] That's exactly what you're doing Adam!
(intense violin music)
I've watched Adam Ruins Everything in the past.
Sometimes I agree, but sometimes I very, very much disagree.
So let's take a look at his episode on hospitals.
Pee-whoop!
- [Patient] I just need to be healthy.
Just give me everything.
- Actually when it comes to medicine,
getting everything could make you less healthy.
- That is a 100% accurate, getting more care isn't
necessarily better than getting less care.
Not only can it be a waste of money,
but it can also lead to over-diagnosis,
which means giving you a diagnosis that had you not
known about it, you'd live a healthy normal life.
Or it can lead to further downstream testing
which then can carry their own side effects.
If I give you an unnecessary test to check
for prostate cancer and then it says you may have
prostate cancer, gives you a false positive,
then you end up getting a prostate cancer biopsy which
is an invasive procedure with a needle down there.
And then as a result of that you get an infection,
and then we find out you didn't really have prostate cancer.
You'd be pretty mad at me right?
- I know a hospital is expensive but
it is worth it if I get the best treatment.
- No it isn't, American healthcare is not the best
in the world, but despite that we spend more per
person annually on healthcare than
any other developed nation.
And a big part of the reason for that is that American
hospitals overcharge patients massively.
- I've seen this show before and I really like how he
takes apart the concepts and makes it easy to understand,
relatable and also it's very data driven.
However, when you take such a complicated topic like
healthcare and you try and water
it down to a single statement,
you're often gonna be misleading people.
America's healthcare system is not the best in the world,
and it's because hospitals are overcharging you,
that's a drastic, drastic oversimplification.
Do hospitals overcharge, yes.
The reasons they overcharge are very important to discuss
because if you just allow the regular person to hear that,
they think hospitals are just trying
to get rich off people getting sick.
It's more complex than that.
- The problem starts with something called the Chargemaster.
The Chargemaster is a secret document full of insane
prices that hospitals use to charge us whatever they want.
- Seven dollars for a single alcohol swab?
That's ridiculous!
- And true.
- Well, I only pay my premium.
If they wanna rip off my insurance company with their
fake prices what do I care?
- Insurance companies have been paying more and more
out of pocket 'cause the hospitals have
been inflating their prices.
The way insurance companies have dealt with this
is they try to keep your premiums from rising too much.
So you don't notice that you're paying more,
but what they do is they make your deductible much higher,
which means that before your insurance even kicks in
you have to pay higher amounts of money.
- Don't have insurance?
You actually get charged these fake prices.
- [Game show Host] Let's see heart X-rays.
That'll be 33,000 dollars.
- This part is interestingly true.
If you don't have insurance and you have to pay out of
pocket you're gonna be paying insane prices.
A lot of hospitals, 'cause I don't wanna make hospitals
to sound like totally evil corporations,
they have charity care programs.
Like my hospital, where they actually subsidize your care.
And if you fall below the poverty line,
you can get care extremely low cost or even free of charge.
This is why I say that it's such
a dense and complicated topic.
Just narrowing down and saying hospitals are evil,
mmm...not exactly the case.
They're not just upping the prices for their own good.
- [Doctor] Every hospital has its own Chargemaster.
A treatment that costs $7000 at one
hospital could cost 100 grand down road.
- And you can't comparison shop when you're dying.
- So this is 100 percent true.
When I talk about the cost of healthcare
or even the cost of drug prices like insulin,
I have to make the statement that you can't treat
healthcare like you do any other commodity.
If a toy is too expensive and
people refuse to pay that cost,
the cost of that toy is gonna go down
or the toy is gonna go off the market.
However, if insulin is too expensive
and you need insulin to live,
whatever cost is set for you you're gonna pay it.
Even if it means going bankrupt in the process
because you need that insulin to live.
And the thing that really bothers me,
there's no transparency here.
You don't know what the pharmaceutical
companies are charging, you don't know what PBMs
which are Pharmacy Benefit Managers
are making off medications.
Without the transparency, you can't make
an educated consumer decision.
For example if you look at an industry where
the prices are transparent like let's say plastic surgery.
If you go to one office they'll tell you what it costs
to get a procedure done then you can go to another office
and they tell you what the procedure is.
The reason they do that is that is 'cause you pay cash.
So they're forced to tell you.
But when you go through insurance,
they're not necessarily forced to tell you.
Therefore it becomes very cloudy
and you can't make a good decision.
This is why prices in the plastic surgery industry
are much better regulated and are much more transparent.
Because they're forced to be, because it's consumer driven.
In healthcare because you don't have a choice,
and because it's going through the insurance company,
and there's no transparency, the whole system falls apart.
- How can I stop it, what do I do?
- Honestly, nothing, we need to go to the hospital so
they have no incentive to change how they do business.
And politicians have spent decades arguing over how
to pay the bill instead of asking why the bill is so high.
- Hospitals need to exist and they
also need to turn a profit in order to exist.
If hospitals just start handing out free care
or not following up on the bills,
or taking lower premiums from insurance companies.
They're gonna go out of business and we're gonna
have no place to get healthcare.
So villainizing the hospital system is not ideal.
Working the entire system and evaluating the
system as a whole and saying the system is failing us,
that's more of the big picture
that we need to be looking at.
Saying that politicians have been arguing at how to
pay the bill instead of actually fixing the problem,
is a 100 percent accurate.
It's so much easier as a politician to get people behind you
to say we should just pay all your bills,
than actually figuring out why the bills are so high,
and getting into the nitty gritty details of them all.
- That's it, I'll get a mammogram.
It won't cure my cold but it will tell me I don't have
cancer so at least I will have beaten one disease today.
I don't understand, I thought every woman
needed screenings like constantly.
- Yeah, that's what doctors and advocacy
groups have told us for decades.
In the 80's, the American Cancer Society even
ran an ad that said if you haven't had a mammogram,
you need more than your breasts examined.
- He wants to make it a very visceral
primitive reaction to what happened in the 80's.
But in the 80's the research that we had at the time,
the best research that we had at the time showed
that by getting mammograms we can extend life and save lives
and prevent people from developing worse breast cancer.
Now, because we did that research and we over screened
people unfortunately part of the course
when you're doing preliminary research.
We've realized that we should push the start date
of when you should be getting your mammograms
to a little bit later in life,
unless you fall into a very specific set of
circumstances like if you have a specific gene
mutation or family history, that sort of thing.
- Based on randomized clinical trials,
if you took 10,000 women in their forties.
Here's how many might die of breast cancer if they
didn't get any mammograms for a decade.
And here's how many of those same women might die
if they did get those mammogram screenings.
- Take off your blindfold, they both look the same.
- Exactly.
- Very oversimplified of how he's presenting the data.
This research that he's talking about is
about people that died that decade.
Not taking into consideration how that breast
cancer effected them in their quality of life,
in the decades moving forward.
But that is the reason in general why we moved
our recommendations to getting screenings later in life,
and getting them less frequently.
Now it doesn't mean you shouldn't get mammograms,
you absolutely should get mammograms.
It's just about when you get them and that's why
I recommend everyone at home to go and talk
to their doctor about what's right for them.
- Mammograms find cancer.
I have many pamphlets that say that.
- [Female Doctor] Well they definitely find cancer,
but not all cancer is the same.
- [Adam] There's the kind of cancer you were thinking of,
the kind you hope to catch early.
- Yeah, that one hasn't reached the finish line yet.
A mammogram could stop it in time.
- It might.
The problem is mammograms can't tell the difference
between these types of cancer.
- That's true but that's why when you get a mammogram,
we don't just do a mammogram and then say oh well you
either have cancer or you don't.
We follow that up with a biopsy which then tells us
which type of cancer it is and that's
how we guide our treatment.
So again, an oversimplification that
can confuse the average person.
- [Female Doctor] There's a chance the X-ray will show
something suspicious when the
woman doesn't even have cancer.
That's called a false positive.
This happens to about one out of ten
women and it can be very stressful.
- [Adam] And the more often you get mammograms,
the more likely you are to get a false positive.
- I try and watch this from an average person perspective.
And when I do that, what I feel is mammograms
are useless and can actually hurt me.
That's not the message we wanna send to people.
The message we wanna send to people is go
talk to your doctor and if you need a mammogram
your doctor recommends them, it's a good thing.
Now challenge them and ask them why or should you wait,
and ask good questions.
But putting the information out to the general public
like this that doesn't have a lot of scientific knowledge?
You can really confuse people and actually
encourage them to not get screened.
Most people will do anything to skip out on
one of these cancer screenings.
And to have a show like this tell them that it's
not the greatest test in the world?
A woman who's 55 will watch this and who already
has a predisposition to not wanna get a screening
will watch this and say I'm just not gonna get it,
and that's not what we want to happen.
- If you do feel a lump or an abnormality please
go see your doctor and if they recommend
a mammogram, get one at that time.
- Exactly that's good advice,
but the problem is all that advice comes after
you just scared the bejeezes out of people who
might actually need mammograms.
So I'm not a fan of the way that this mammogram special
was presented, even though factually accurate.
- There is some good news, our treatment of breast
cancer is so much better than it used to be.
The mortality has dropped significantly.
- The reason why our treatment is so much better
is because we found so many of
these cancers early because of mammograms.
They spent all this time knocking mammograms,
at least give credit to mammograms for causing
breast cancer mortality rates to drop.
- [Female Doctor] One in eight in a lifetime,
and it's of a diagnosis not of death.
- I see, I see, that's the problem with statistic is that
they can play into, if they're not framed just right
they can play into the more fearful parts.
- That's exactly what you're doing Adam.
I mean yes, we don't say one in eight women will die
from breast cancer we say they'll develop it.
So if you're being clear with the statistic that you're
giving, a patient or a person can make their own decision on
how they feel about that statistic.
Adam has great intentions and he wants to present
information, he wants it to be controversial and edgy
and disruptive, and that's good.
But unless you've had clinical experience where you
understand how patients normally come in.
You won't be able to tailor that
information to do something meaningful.
Like if I was to make this show,
I would make it with the presumption and the knowledge
that patients come in generally afraid of mammograms.
And I would be able to tailor the show with that in mind.
And maybe it won't be as funny or edgy or disruptive,
but at least it'll be meaningful.
'Cause that's the idea of making quality health content.
It's to not only entertain but to somehow give
a piece of education that's gonna make a lasting impact.
And that's why have to always measure the intentions
and then see if the outcomes match the intentions.
'Cause I bet if I show this to a 100 women who are let's say
at the age let's say 50 years old to get a mammogram.
And I let them watch this really quickly,
and ask them what they feel about mammograms after.
I guarantee you the majority of them will be more turned off
on mammograms even though they shouldn't be,
because of this show, and that's a negative outcome.
Did you see where Dr. Mike ruins Detox Teas, click here.
And stay happy and healthy.
(chill electronic music)