"(coughing)" "Rachel, sick again?" "What a surprise." "I feel terrible." "I'm gonna need a ton of antibiotics." "Plus a full body CAT scan." "Complete blood work for all diseases native to California." "And two lollipops from that bowl there." "(sniffles) Cherry, please." "You know the tenth visit isn't free, right?" "Don't care." "I took the whole day off from work, so I'm not taking any chances." "I just need to be healthy." "Just give me everything." "Actually, when it comes to medicine, getting everything could make you less healthy." "I'd also like my eyes checked." "No, I'm real, and I've got exactly what you need." "Medicine?" "Knowledge, 'cause I'm Adam Conover." "And this is" "(sneezes) Bless you." "And this is" "(sneezes) Bless you." ""Adam Ruins Everything." (sneezes)" "You know what?" "Let's just roll the intro." "**" "Closed Captions Provided by truTV" "Hold up, Dr. Dingbat." "Of course I want as much medical care as possible." "What could be the downside?" "Oh, there are a ton." "For starters, how 'bout the fact that this place rips off folks like you every day." "Whatever." "I know the hospital is expensive, but it is worth it if I get the best treatment." "No, it isn't." "American health care is not the best in the world." "But despite that, we spend more per person annually on health care than any other developed nation." "And a big part of the reason for that is that American hospitals overcharge patients massively." "(music playing, cheering and applause)" "This neck brace is worth $20." "But the hospital charged him... $154." "This I.V. bag cost less than a buck." "But she was charged $137." "These are real prices, folks." "Hold up." "Wildly inflated health care costs?" "This sounds like the work of politicians to me." "Was it Obamacare?" "Trump Aid, McConnell Med?" "What did you do?" "!" "I'm not a politician." "I'm just a boring white guy." "Why does this keep happening?" "Sorry, Rachel, but this time, it's not the politicians' fault." "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." "Let's go on a trip through the history of medical billing." "Well, I'd rather not." "(Adam) A hundred years ago, hospital pricing was pretty simple." "We take the cost of providing care and add a little on top to make a profit." "One amputation costs us five bucks." "So we'll charge you 6.50." "But after the rise of insurance companies, hospital billing got complicated, in part because these gigantic corporations demanded gigantic discounts." "We send you thousands of patients every day." "So, we want... half off all your prices." "We can't afford that." "So, to please these powerful insurance companies, hospitals cooked up a plan." "I've got it." "We'll make up a really, high fake price, and then give you a discount off that." "Hey, as long as I get to tell my boss we got it cheaper." "(laughter)" "(laughter)" "(Adam) And in less than a century, health care prices went from reasonable to nonsensical." "Let's make one Tylenol $37." "Three stitches, $2200." "Ooh, here's a pitch." "What if we made rectal exams 69" "Nah, that's too silly even for me." "**" "These crazily inflated prices are kept in the hospital's Chargemaster." "(coughs)" "It's actually a computer file." "But the book is more dramatic." "$7 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?" "If you ever lose insurance, you'll care." "Because here's the really evil part." "If you don't have insurance, you actually get charged these fake prices." "(studio audience cheering and applauding)" "Let's see, heart X-rays." "That'll be $33,000." "I can't afford that." "No problem, we'll just garnish your wages." "Oh, bogus." "Wait, they actually charge people without insurance fake prices?" "Yeah." "That is terrible." "Well, thankfully, I have insurance, so the Chargemaster doesn't affect me." "Unfortunately, it does." "Even if you're insured, you can get billed" "Chargemaster prices if you go out-of-network." "And anything can be out-of-network." "The hospital you go to, the equipment used to treat you." "Even the doctors you see." "Arrow specialist." "Out-of-network, I am very expensive." "Hospitals make a ton of money overcharging out-of-network patients." "It's a real cash cow and we all get milked." "(cow mooing) Worse, every hospital has its own Chargemaster." "A treatment that costs 7,000 at one hospital could cost a hundred grand down the road." "And you can't comparison shop when you're dying." "Which hospital do you want?" "Money Bags Medical or St. Vincent's Discount Sick House?" "Money Bags it is." "Plus, since your insurance company faces inflated costs," "That can trickle down to you in the form of... higher premiums." "Oh, surprisingly painless." "Wait till you get the bill." "(cow mooing)" "How do they get away with this?" "Simple, the health care industry spends more on lobbying than the oil and defense industries combined." "(cash register rings)" "(men babbling)" "Thanks, Doc." "I'll take care of you real nice." "Say, does this cyst look normal?" "Oh, God." "So, 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?" "Until they do, we're stuck with this system." "God, what if I get fired and lose my insurance?" "I would be ruined!" "I feel so anxious." "(woman over PA) Rachel, the doctor will see you now." "Down the hall and to your left." "Well, then, if I'm gonna get ripped off," "I might as well score some antibiotics." "I wanna be done with this cold, and those miracle drugs are worth whatever they cost." "Even if it means the end of modern medicine?" "You are the worst person I have ever met, and I work in finance." "Harsh." "(woman over PA) Paging Dr. Dingbat to the O.R." "Oh, I thought I'd lost you." "I don't wanna hear you bad-mouthing antibiotics." "I have a cold and they're gonna cure me." "No, they won't." "Colds are caused by viruses, not bacteria." "So, antibiotics won't help them." "But more importantly, our misuse of antibiotics could mean the end of modern medicine." "I find that hard to believe." "I'll walk you through it." "Before antibiotics, if you got an infection, there was a high chance you'd die of it." "He's right!" "This guy stepped on a nail." "Good change he'll die." "This woman had minor surgery." "Great chance she'll die." "All of these people will probably die!" "Being a doctor in the past is fun." "But all that changed in 1928 when one scientist got super lucky." "One weekend, Alexander Fleming accidentally left out a Petri dish filled with bacteria." "And when he returned, he found that the bacteria had been destroyed by mold." "This led to the discovery of the first antibiotic, penicillin." "It saved countless lives and earned Fleming the Nobel Prize." "What's the issue then?" "Seems like everything is great." "For a few decades, it was." "Until the rise of resistant bacteria." "When you take antibiotics, you're trying to kill all the bad bacteria in your system." "But sometimes, like if you don't finish your antibiotics, or just through random chance, a few of these bio bullies develop resistance." "(screams) (whimpers)" "(surprised) I'm okay." "(defiantly) I'm okay." "I'm resistant!" "Once that happens, resistance can spread." "(Adam) First to other bacteria..." "Mwah!" "Mwah!" "... then to other people." "(bacteria) Mwah!" "Over time, these protected pathogens can propagate all over the planet." "And when that happens, the antibiotic becomes useless." "Once you start using a new antibiotic, it's only a matter of time before resistance develops." "Penicillin was a miracle drug." "But bacteria became resistant to it in just a few years." "But there are other antibiotics, right?" "Please say yes." "Yes, but the same thing is happening to them, too." "And we're speeding that process up because antibiotics are insanely over-prescribed." "Even though they have no effect on colds and flus, doctors hand out antibiotics to patients just because they ask." "I got a cold, Doc!" "Give me some of those sweet, sweet pills." "Oh, it won't help, but sure." "Some anti-B's for my anti bae." "(laughing)" "According to the CDC, at least one-third of antibiotics are unnecessarily prescribed." "And 80% of these precious drugs aren't even used for medicine." "They're given to farm animals." "(chicken squawks) Mother Falcon, come on!" "Because of all this overuse, our supply of effective antibiotics is dwindling." "Then we need to invent more and fast!" "Uh, that won't be easy." "Rachel, this is Dr. Arjun Srinivasan." "An expert on antibiotic resistance at the CDC." "Rachel, antibiotics are really tricky to develop." "So, it takes a long time." "In fact, we haven't had a totally new class of antibiotics since the late 80s." "What have you scientists been doing all this time?" "Well, we're trying, but it's also hard to convince pharmaceutical companies to make new antibiotics because they don't make a lot of money." "Yeah, they just, uh, save lives." "Right, we need to encourage these companies to make these lifesaving drugs." "And in the meantime, we need to start using the ones that we have like a precious resource." "We are dangerously close to the end of antibiotics." "Um, what happens then?" "I'll show you." "Thanks, Doctor." "No, Adam, wait for me!" "(mechanical whirring)" "(grunts, electrical shorting)" "If antibiotic resistance becomes the norm, infections will come back in full force." "And we'll lose the ability to safely perform organ transplants, chemotherapy, and even routine surgeries." "All of modern medicine is built on a foundation of effective antibiotics." "If we lose them, we lose everything." "The bad old days will be back again." "(maniacal laughter)" "No!" "No!" "We cannot go back to the Dark Ages." "We need to conserve our antibiotics." "Hey, you still want a taste of these anti-B's, baby!" "Got the newest ones in my pocket." "Listen, lady, just because I can be pushy when I'm sick, doesn't mean you should just give me what I want!" "I'm sorry, the patients are so mean, and it makes them happy when I give them pills." "(crying)" "(loud sneeze)" "Gesundheit." "Oh, I still feel like crap." "(sniffles)" "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." "You can't possibly have anything to say about mammograms, Adam." "Actually..." "Nope." "I'm not listening to you talk about boobs." "Yeah, I can see how this one's gonna be tricky." "**" "Stupid Adam thinks he's so smart." "Well, not this time." "I didn't get the care I wanted because it would have bankrupt me." "I didn't get antibiotics because it would end medicine as we know it." "But a mammogram is a no-brainer." "(knock on door)" "Hi." "Hi." "I'm Dr. Elmore." "I'm Rachel." "Nice to meet you." "How can I help you today." "I don't wanna seem pushy, but I need a mammogram, now." "Can you tell me a little bit more about why?" "I haven't found a lump or anything." "I just need to get screened so I know I don't have cancer." "Okay, let me sit down and let's talk about this." "Cancer screening is a complicated topic." "I looked at your medical record before I came in and it says that you're 35 years old." "You don't have any family history of breast cancer." "No risk factors, correct?" "Then I would not recommend a screening mammogram today." "Why on earth not?" "Breast cancer is something that many of us fear." "Many of us have loved ones who have suffered from it." "But the truth about screening mammograms is that the benefit is less than we had hoped, and there are real harms, more than people think." "You sound like that human internet comment." "Oh, you must mean Adam." "We were just talking with Adam about this at book club." "(Adam, through door) Dr. Elmore, is that you?" "How's the family?" "Fine, Adam!" "You can come in." "I'm not looking, very respectful." "(chuckling)" "Rachel, this is Joann Elmore." "She's a doctor, professor at University of Washington and an expert on breast cancer screenings." "Adam, I'm over here." "(loud gasp)" "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 80s, the American Cancer Society even ran an ad that said "If you haven't had a mammogram, you need more than your breasts examined."" "Wow, that's insulting." "Heh, par for the course for the 80s." "But in the last few years, new research has caused some of the recommendations to change." "The American Cancer Society, the US Preventative Services Task Force and the American College of Physicians have all recommended getting mammogram screenings less frequently and beginning them later in life." "Ow!" "Really?" "Why?" "While screening mammograms can and do save lives, the actual number of lives saved, it's much smaller than most people think." "Based on randomized clinical trials, if you took 10,000 women in their 40s, 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." "There was no statistically significant difference between the women who got the mammograms and the control group." "How can that be?" "Mammograms find cancer." "I have many pamphlets that say that." "Well, the definitely find cancer, but not all cancer is the same." "How do you think cancer works?" "Well, it starts with one bad cell." "It multiplies and spreads and if you catch it early enough, then you survive." "And if you don't, then your friends and family run a 5K every year." "That's what a lot of people think." "But the truth is a lot more complicated." "Some cancer grows so fast that mammograms can't catch it in time." "This is an awful thing to win!" "(Adam) But some cancers start growing, but then stop before they kill you." "And other cancers grow so slowly, they would never have the chance to kill you." "Finally, 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." "(beep)" "The problem is mammograms can't tell the difference between these types of cancer." "Oh, I can't tell you apart." "You all look deadly to me." "I'm gonna treat you all the same." "You're so sexy when you detect cancer." "That is less helpful than I thought." "But if there's even a tiny chance it'll save my life, it does seem worth it for a harmless test." "Unfortunately, mammograms aren't harmless." "(Joann) 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." "And the more often you get mammograms, the more likely you are to get a false positive." "Over half of women in the US who receive annual mammograms will experience a false positive within a decade." "(Rachel) But, okay, sometimes they do find cancer, right?" "The screening could just find one of those harmless cancers that would never kill you." "(Joann) That's what we call over diagnosis." "Estimates are that about one in five cancers mi be overdiagnosed." "(Rachel) That's really high." "(Adam) Consider the emotional and psychological stress of thinking you have a deadly disease when you don't." "Or having to tell your loved ones." "Those are real harms." "(Joann) And over diagnosis can lead to overtreatment." "Since mammograms can't tell the difference between these types of cancers, we recommend serious treatments for all of them." "And that can result in women getting treatments they don't need." "(Adam) Some, like, chemotherapy, radiation therapy, and mastectomy take a serious toll on the body." "(Rachel) So, you're telling me I could have that lazy cancer that would never have hurt me, but still be told to get chemo?" "(Adam) Yeah, it's entirely possible." "(Rachel) Holy crow." "Taken together, given the false positives, overdiagnosis, overtreatment, instead of rushing in to get screening," "I want women to weigh all of the data and make an informed choice." "Prostate and thyroid cancer screenings have the same issue, by the way." "You know, I used to get my prostate checked twice a week before I found this out." "So, what should I do?" "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." "Apart from that, the US Preventative Services Task Force recommends talking to your doctor in your 40s about whether you wanna start screenings then." "And otherwise, they suggest getting them every two years starting in your 50s." "That's when the benefit is more and the harms are less." "I guess I, I won't get one today then." "There is some good news." "Our treatment of breast cancer is so much better than it used to be." "The mortality has dropped significantly." "And we're able to cure most women with breast cancer regardless of whether the cancer was detected on a screening exam or not." "Thanks, Dr. Elmore." "See you at book club." "I'll bring my usual." "Baloney dip and opinions." "(man coughing)" "Rachel..." "Are you upset?" "Yes." "I came here because I wanted to feel better." "But now I know that the hospital will bankrupt me, antibiotics will end the world, and I won't get a mammogram until I am 50." "If doctors and hospitals won't make me feel better, maybe nothing will." "(woman over PA) Paging Adam Conover for the positive takeaway." "On it, stat!" "Also your bike's been towed." "Oh, man!" "**" "Hey, guys, I'm here on the set of "Adam Ruins Everything"" "with Dr. Joann Elmore." "We got more questions about mammograms for her." "Um, you make this distinction, though, between screening mammograms and diagnostic mammograms." "Can you explain that to me?" "That's an important point in that screening exams are when the women has no symptoms, she's healthy." "And the goal is to try and detect cancer early when we can offer easier treatments and hopefully save lives." "That's the checkup version." "Right." "And diagnostic mammograms," "I obtain them when women come in and they have a lump or a suspicious abnormality." "And then we get a diagnostic mammogram." "The research that you've done about the, the rate of false positives and etcetera, that's all based around screening mammograms." "That's right." "And tell me a little bit more about that research." "Well, I did it because I had a lot of women calling me up anxious." "They were getting this letter that said Dear Mrs. Smith, don't worry, but you had an abnormality on your breast mammogram." "And, uh, so we just quantified how often that happens." "And what your audience should know is that this happens very frequently in the United States." "One out of ten women that go get a mammogram will be asked to come back for additional testing." "And so, I hope if women know that that's just part of the screening test, that they hopefully won't be as nervous." "It's kind of like how you set your smoke detectors." "You know, at what level do you want them to go off?" "We don't wanna miss cancer." "But we may have it a little bit" "Yes, when you're cooking, if your smoke detector's too sensitive and every time you cook anything... beep, beep, beep..." "You gotta get up on the chair." "And that's okay if it's just an annoying noise, but if it's talking about your body and it's very frightening and stressful, you don't want that false-- that false alarm actually has real harms." "It's a fine balance." "As a doctor, what are the misconceptions that people come in with about breast cancer." "That's a good question." "Probably one of the biggest is this underlying fear and anxiety about breast cancer." "Women think it is more common than it actually is." "Really?" "Women hear this one in eight women with breast cancer." "And it's actually a statistic that is one in eight in a lifetime and it's of a diagnosis, not of death." "I see, that's the problem with statistics is that they can play into, if they're not just framed just right, they can play into the..." "Right." "... more fearful parts." "Right, I'll have a 20-year-old come into clinic." "And they'll be all worried about breast cancer." "And they wonder why they shouldn't get screening mammograms." "And I'll tell them, you know, your chance as a 20-year-old of getting breast cancer in the next five years, it's the same as a 70-year-old man." "Really?" "(laughing)" "Well, and then they say, what, you don't get mammograms on 70-year-olds." "And I kind of say, yeah, that's why we're not recommending it in 20-year-old women." "And 70-year-old man, there's a small chance they'll get breast cancer." "Oh, yes, one..." "A small, small percentage of breast cancers actually occur in men." "I actually didn't know that." "That's really interesting." "Yeah." "Why do you think there is this sort of emphasis or, uh, reliance on mammograms." "Everybody thinks, okay, what's the number one thing" "I should do to fight breast cancer." "Go get a mammogram right now." "That's sort of our first thought." "Wish I had an easy answer." "I think it's complicated." "Yeah." "You know, just the whole history of the breast and culture and in politics and in the media." "And there's the heightened fear." "I think that we also have oversold medical technology." "I hate to say that as a doctor." "Mm-hmm." "Um, because I'm a physician and I care about medical care." "But, um, no medical test is perfect." "Hmm." "So, I wanna educate women about the pros and cons and part of the good news is that our treatments are so much better than they used to be." "And we can save a lot of lives now that we weren't able to in the past." "Well, thank you so much for coming on the show to talk to us about it." "I really appreciate it." "My pleasure." "(sirens wailing)" "Hey, I didn't mean to make your sick day any harder." "I was just trying to help." "You need to understand something." "I am not crazy for worrying about getting sick." "People do get sick and people do die." "And coming here used to make me feel like" "I had some control over that." "I know." "I didn't really need all those treatments and tests for my stupid cold." "Just made me feel better." "'Cause I'm afraid of doing too little." "I know, but often doing too much can be worse." "It can bankrupt you or deplete lifesaving drugs." "Or even hurt your health." "If you're actually sick, please go to the doctor." "But going out of anxiety or fear..." "That's not a good thing." "I know." "I just don't know how to relax about this stuff." "None of us do." "In the United States, we undergo 100 million CT and MRI scans a year and almost ten billion lab tests." "We're overtreating ourselves to the tune of $226 billion a year." "We pay more per person in health care than any other country, and we're not any healthier for it." "And maybe part of fixing that is worrying less and doing less." "(chuckling)" "That's kind of liberating when you think about it." "**" "Less is more." "Yeah, and the best part is, you can still have a lollipop." "Cherry." "Wow." "You're right." "Thanks, Adam." "You know, you're not such a bad guy after... (loud sneeze, music stops abruptly)" "Oh!" "Sorry." "Do you want some tissue or some hand sanitizer." "Oh, you know, a lot of people say hand sanitizer is bad." "But the evidence is totally out on that." "If you have an extra seven minutes, I could" "Oh, wow, she is really booking it." "Derek, we have to end this." "What?" "Why?" "Because my husband's coming out of his coma." "And you're about to go into one." "Kiss me." "Kiss me like you did for the first time after you came out of your coma."