All language subtitles for Adam Ruins Everything s02e03 The Hospital.eng

(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

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.

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