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The $11 Billion Mammogram Industry No One Questions · Intellectual Medicine

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  Do you want a mammogram, Dr. Let me think about that.
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  I'll get back to you. In America, we've become very
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  protocol driven, dogmatic, rigid.
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  The protocols are there really to make the system more
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  efficient. What do they mean?
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  That means more dollars per hour.
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  That's it. It's business efficiency.
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  It's not necessarily in the best interest of patients of us.
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  You have this horrible thing called health insurance.
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  Do not become a slave to your health insurance.
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  Keep thinking, keep asking questions, be careful when you
• 0:39
  are feeling pressure, pause. Think twice.
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  Don't do something irreversible in a moment of anxiety when a
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  pause would serve you out. OK, I'm just going to come right
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  out and say it. Most women should just stop
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  doing mammograms. Now that is a heretical
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  statement. But by the end of this podcast,
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  you'll understand why I have that opinion and why research
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  supports me. In America we become very
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  protocol driven, dogmatic, rigid.
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  The protocols are there really to make the system more
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  efficient. What do they mean?
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  That means more dollars per hour.
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  That's it. It's business efficiency.
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  It's not necessarily in the best interest of patients of us.
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  This idea about mutual decision making, right?
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  In a perfect world, you'd sit there with your doctor and you'd
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  talk about it, you know? Should I get APSA?
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  Should I get a biopsy? Should I get a mammogram?
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  Let's have a conversation. That doesn't happen.
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  This is how it goes. Oh, you're due for your
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  mammogram? I'll schedule it for you.
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  Period. End of conversation.
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  How does this unfold? It robs you of thoughtful
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  processing. A protocol takes the place of
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  thinking. Dogma ensues.
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  Paradigms become petrified. Everybody gets paid.
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  What about you? What about you?
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  So let's talk about the mammograms as an example of what
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  afflicts medicine in general. You folks, it's up to you.
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  Medicine isn't going to change because Doctor Petr Rudi is
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  suggesting different approaches now.
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  Maybe a little bit. We hope it's going to change
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  because you demand it. You want better results.
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  You want conversation. You don't want to be fear
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  driven. You don't want to be extorted or
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  forced into doing things against your will.
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  I'll tell you a story about a woman recently did a a
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  consultative appointment for her.
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  She wanted my thoughts about an abnormal mammogram.
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  The mammogram had an 8mm lesion in it.
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  Woman was in her 70s. They want to do a needle biopsy.
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  I mean, good luck even finding that little thing.
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  She declined. OK, it's her prerogative, right?
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  It's her body. It's her choice.
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  The doctor sent her a certified letter kicking her out of the
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  practice. Can you imagine?
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  Talk about coercive leveraging. If you don't do, XI will not be
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  your doctor. That's terrifying.
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  It's hard to find doctors that's wrong.
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  That should never happen. I don't care what the research
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  supports. What matters the most is the
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  decision you make. And now, fortunately, we have
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  each other. You have the Internet, you can
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  find information. I'm going to help you with that
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  a little bit right now. Why do I say that women should
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  consider not doing mammograms or at least think twice, right?
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  A major study in Canada. This was the Canadian National
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  Breast Screening Study published in the British Medical Journal
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  in 2014. They looked at over 80,000 women
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  and they divided them into two groups.
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  One group had mammograms, the other group did nothing.
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  They didn't do any mammograms and they tracked them.
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  What they found was that there was no difference between the
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  two groups in death from breast cancer.
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  Wait a minute. Isn't that what mammograms are
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  supposed to prevent? It turns out, maybe not.
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  A study done in Sweden looking at all the outcomes regarding
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  mammograms concluded. I'm going to quote this one.
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  Screening for breast cancer with mammograms is unjustified.
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  They found a higher death rate in women who got mammograms.
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  What's going on? The dogma says early diagnosis
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  is key to survival. The research says, hey, not so
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  fast. In the Canadian study, yeah,
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  they can pick up some cancers a little bit sooner than if a
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  woman just did self breast exams.
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  They'd pick them up a little bit sooner, but it didn't make a
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  difference regarding the outcome.
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  The survival rates were the same.
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  That's not because the mammograms are so slick, it's
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  because of advances in treatment.
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  In addition, they found the women that get had mammograms
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  had a bushel of false positives. Anxiety, Repeat mammogram cone
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  view. Come back in six months, come
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  back again in six months. You know the drill.
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  Anxiety inducing, fear driven. Why are we doing this?
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  I'll tell you why in a minute. In China, a study compared
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  ultrasound to mammogram. Conclusion.
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  Ultrasound was better than mammograms for assessing and
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  diagnosing breast cancer. Why are we doing X-rays?
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  Why do we expose an organ, the breast, that is cancer prone to
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  a cancer causing entity? Ionizing radiation.
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  How much radiation is too much? There is no threshold, folks.
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  It's a linear risk. The more exposure, the greater
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  the risk. Now, I ask you, how many
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  millisieverts of radiation have you been exposed to in your
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  life? Right.
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  You have no idea. Nobody talks about it.
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  They said we're going to do an X-ray.
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  We're going to X-ray. We'll get an X-ray.
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  We'll get an X-ray. We'll get an X-ray.
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  Sometimes is a doctor's equivalent of a pause.
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  Your back hurts. Let's get an X-ray.
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  Your back hurts. I got to get you out of this
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  office in the next couple of minutes.
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  I know the patient waiting and I'm not going to be able to
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  figure out what's wrong with your back in that time, but I'll
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  amuse you by ordering an X-ray. That's going to show me nothing
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  important. We know that in most cases, but
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  there you go. Micro milli sievert of radiation
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  cumulative over your lifetime, linear risk.
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  Is it possible? Now we're seeing a lot about
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  increase cancer rates in younger people.
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  Why is it possible? We're just irradiating the heck
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  out of folks in a way that is creating the cancer.
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  It's possible. Well, why not do ultrasound?
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  I'll tell you why they don't do it.
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  Because X-rays were discovered first.
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  X-rays predate ultrasound technology by about 50 years.
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  So a business developed around X-rays.
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  The breast health centers are built around mammograms.
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  We're talking billions of dollars.
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  Do you think they're going to look in the mirror and go, ha,
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  you know, maybe doing all these X-rays is not such a good thing.
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  Maybe we should stop doing mammograms.
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  And if we're going to do any imaging, perhaps we should do an
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  ultrasound instead. And ultrasound has been shown to
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  be at least equivalent, if not better.
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  There's no radiation exposure, and it doesn't hurt.
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  Gee, I'm going to shut down my breast imaging center.
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  That's not going to happen. We're talking $11 billion plus
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  per year. This, folks, is what petrifies A
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  paradigm. It petrifies A dogma.
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  The reimbursement is just too good to walk away from.
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  But you can walk away from it. Say, look, doc, I don't want to
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  remember. Whoa, they're going to have
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  kittens. Well, it'd be reasonable to ask
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  them if they have any ownership stake in the Breast imaging
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  center. I mean, I'm just speculating.
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  Doctors do that. Look, you got to make a buck.
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  I get it. The other problem with the
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  advice is the employed primary care doctor.
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  Doctor Pedroudi works for Charter Health Incorporated.
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  My check comes from the big boss.
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  What do you think they want me for?
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  Because I'm really brilliant and I can diagnose things without
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  having to do a lot of tests Because I don't refer to
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  consultants that much because I manage things?
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  Heck no. They want you to churn to churn.
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  The profit making entities, labs, X-ray, imaging referral,
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  primary care has lost its freedom now.
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  You can still find them out there.
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  You want to find a primary care doctor unaffiliated with any
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  other entity. You might have to pay out of
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  pocket for that. Folks, I'm sorry, but you may
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  you have this horrible thing called health insurance.
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  Do not become a slave to your health insurance.
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  It's not as expensive as you think.
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  Suppose you said, look, I don't want a mammogram, but I'm
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  willing to pay for an ultrasound.
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  That should cost you no more than 250 bucks, right?
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  For an cash out of pocket, I'll pay.
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  Why? Because the insurance company
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  won't pay for it. What?
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  Unless you get a mammogram first.
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  That's just stupid. That's just backward.
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  So should you get a mammogram? Let's be a little more nuanced.
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  Risk varies. If you're a petite, lean woman
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  with AC cup or less, there's no place for cancer to hide.
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  A self breast exam is quite excellent.
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  You'll find a lump that's relevant and have it assessed.
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  How about if you're a £250 woman with double D cup?
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  Imaging has more value because it's harder to.
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  It's harder to feel something right, so the body habitus
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  matters. This global recommendation that
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  everybody needs a mammogram ignores that reality.
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  And God forbid you get a mammogram if you've had breast
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  implants. They're going to squish the heck
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  out of them. So should you get a mammogram?
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  I'm not in favor of them. I understand the rationale.
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  I understand the dogma. It's not wrong to get one,
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  though. Some women get Peace of Mind
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  knowing they had the mammogram. But remember, a mammogram did
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  nothing to prevent your cancer. Nothing.
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  It increases the risk. Let's talk about primary
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  prevention. How about that?
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  How about your lifestyle? How about percent body fat?
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  Right. But if it gives you comfort,
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  it's your prerogative. You ought not to be forced.
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  You ought to be given balanced information.
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  You ought to be applauded in your autonomous decision making.
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  If breast cancer develops, you can take comfort knowing that
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  the evidence does not support the mammograms would have
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  significantly altered the outcome.
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  Now, if you're going to do imaging, I like ultrasound over
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  mammogram, and if the ultrasound is questionable, I like an MRI.
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  An MRI is more detailed and can help you avoid biopsies.
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  Biopsies are the default, once again, dogma.
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  It's kind of like, kind of like prostate biopsies, right?
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  But we're going to do the biopsy.
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  We'll do the biopsy, we'll do the biopsy.
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  Everybody gets paid and the biopsy gives them medical, legal
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  protection. I did the biopsy.
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  A study looking at women with highly suspicious lesions in the
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  breast, looking at two different groups.
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  One group had a biopsy done first.
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  The other group did not do the biopsy, but rather went directly
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  to a lumpectomy. These are for highly suspicious
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  lesions. That's where the MRI comes in.
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  They found that there was a significant increase in
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  metastatic disease in the women who had the needle biopsy first.
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  Folks, you stick a needle in cancer, you can spread it.
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  All right? Can we apply that basic logic
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  and can we really push back on the doctors that are telling us
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  that there's no evidence that that can happen?
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  You never looked, whether it's the prostate, the breast or
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  elsewhere. So pushing back, asserting your
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  autonomy, accepting the unknown consequence of your decision
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  because they're all unknown. There is nothing out there
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  that's going to give you what we really want, absolute
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  reassurance. Look how many folks have had a
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  normal mammogram and six months later get cancer.
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  Yeah, that happens. Not suggesting that it's bad to
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  have a normal mammogram, but it may not be that fruitful to take
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  comfort in that study. False comforts, people.
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  They propel imaging, they propel procedures.
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  They pro doctors can be bad for your health.
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  You got to be careful. You want the kind of Doctor Who
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  moves slowly, who talks more than he or she does, so that
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  your process is contemplative. The time I want my doctor to
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  move fast is when I'm dying of a heart attack in the emergency
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  room. OK, that's where I'm cool with
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  not having a big conversation. But hopefully what we're doing,
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  health support, makes those events less likely to happen.
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  So should you get a mammogram? I don't recommend it, but my
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  word is not the last word. The last word is yours.
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  Conversation with your doctor if you want to get a mammogram,
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  there's nothing bad about. There's nothing wrong with that
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  decision. I'll say that.
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  Nothing wrong with it. It may be.
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  It's possible that the mammograms will actually prevent
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  death from breast cancer. There may be studies forthcoming
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  or some that I don't even know about that have strong evidence
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  of that being the outcome. I haven't seen it, but for you,
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  the individual, that's what matters.
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  So let's go back to my patient who got the termination letter
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  out of my practice. Man, that just angers me Should
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  never happen. Kick you out really if you don't
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  do what I tell you to do, but I'm sorry, but if you don't do
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  what I tell look at. I want you guys to comment on
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  that. What are your thoughts?
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  Should a doctor kick a patient out of a practice for failing to
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  follow their recommendations? I'll argue with the doctor's
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  side. Well, if they don't want to do
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  my treatment that I recommend, I don't want to be their doctor
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  because I don't want to be responsible for the outcome.
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  OK, that's one rationale. How about this?
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  You just put in your record. This is what I recommended for
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  my patient. Patient declined, Boom, it's
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  done. You don't have to throw the
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  patient out, in my opinion. Well, guys, thanks for taking
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  time with me. Keep thinking, keep asking
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  questions. Be careful when you are feeling
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  pressure. Trust your instincts.
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  Pause, think twice. Don't do something irreversible
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  in a moment of anxiety when a pause would serve you well.
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  Do you want a mammogram, Dr. Let me think about that.
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  I'll get back to you, I haven't decided yet.
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  Fair statement. Can I get an ultrasound instead?
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  I'm I'm willing to pay for it. Really. 250 bucks?
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  I get it. For some folks that is a big
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  deal. That would be a barrier.
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  Well guess what? A self breast exam is free at
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  one point. I don't know if this is still
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  the recommendation but they advised against self breast
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  exams. What's the logic behind that?
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  They think you're too stupid to be able to discern 1 lump from
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  the next. You don't need to be a doctor to
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  do a self breast exam. You have fingers and a brain and
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  what you're looking for is it's a marble in the sand.
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  You're looking for something that stands out from the crowd.
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  And if you do it once a month, you'll get familiar with the
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  anatomy. All right, folks.
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  Well, from the front line of intellectual medicine to your
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  own, Thanks for taking the time with me.
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  Look forward to our next time together.
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  Bye.