Adam Ruins Everything (Season 2, Episode 3: Adam Ruins the Hospital): challenging beliefs and misconceptions about hospitals and medical treatments

Tim Wilkime, “Adam Ruins Everything (Season 2, Episode 3: Adam Ruins the Hospital)” (2017)

Hosted by eponymous comedian and writer Adam Conover, “Adam Ruins Everything” is a comedy / education TV series that aims to challenge commonly held beliefs and misconceptions about many aspects of everyday life, in particular the everyday goods and services that people take for granted. In this episode, Adam visits Rachel (Melissa Tang) who has arrived in a hospital to get treatment for a head cold and perhaps get her mammogram done. In a relentlessly cheery fashion, Adam helpfully informs Rachel (and the show’s intended US target audience) how and why inflated hospital costs have led to medical care being out of reach for the majority of Americans, with the poor being hit the hardest of course, why antibiotics are not as effective as they used to be and may in fact be worthless, and that mammograms have been oversold to women fearful about their health with consequences that may actually be as harmful (if not more harmful) than breast cancer itself.

Potentially the most interesting part of the episode is the chat about ascending hospital costs and how hospitals determine the cost of medical (including surgical) procedures to patients. Most US hospitals refer to chargemasters (often their own) which are lists of medical items billable to patients or their health insurance funds. The prices of items are usually inflated way beyond what their actual cost so that hospitals can offer “discounts” to patients who belong to certain health funds. In addition, wealthy patients or insured patients can bargain down the cost of an item with hospital administration staff while the poor or uninsured patients have to pay full prices. Disturbingly, in most US states (apart from Maryland) hospitals can set their own chargemasters and there is often no regulatory authority that would oversee chargemasters and force hospitals and other medical treatment centres to make these publicly available so that people can shop around and make price comparisons. Unfortunately the swift pace of the episode means that the issue of escalating hospital costs can lose viewers if they happen to look away for a few seconds, and the treatment of the issue looks a little superficial. I’m sure also most viewers would have wanted to know how this state of affairs came about and who was / were responsible for this shambles.

The issue of declining antibiotic effectiveness is crisply well done with animation demonstrating how bacteria can become resistant over time to antibiotics. Once again though, there’s not much on how people themselves can ensure antibiotics are not abused (by feeding them to farm animals whose meat ends up in butcher shops and delicatessans) at a personal level such as washing one’s hands thoroughly and not overusing anti-bacterial soaps and handwash, or at a community level by protesting the use of antibiotics meant for humans in commercial agriculture.

Finally the question of how effective mammograms really are in detecting breast cancer in women before they notice symptoms comes in with an interview with Dr Joann Elmore who explains that there’s not much statistical difference between the number of women who discover they have breast cancer through mammograms and the number who find their breast cancer without the help of mammograms. She also explains that breast cancer cells may behave very differently, some being more aggressive than others. There is the possibility that some women may be diagnosed with breast cancer via mammogram who do not actually have the disease or have a slow-growing cancer, and can end up subjected to major medical procedures that are completely unnecessary and which could jeopardise patients’ long-term health.

The information is delivered in a fun way with slapstick and serious medical advice given equal time. With his surf-wave haircut, guileless manner and a mouth that never stops moving, Adam ploughs through three quite meaty medical issues with a raging and sneezing Rachel in tow. I’d have liked the episode to be a bit longer – another 15 minutes please? – with more information on how the US has ended up spending more on per capita healthcare costs than any other First World country yet Americans seem no healthier than other First World nations and could possibly be some of the least healthy people on Earth.