1348: Medical Tourism | Skeptical Sunday

24:50Other countries are not known for having excellent medical systems. And generally sort of the cheaper the cosmetic surgery is, the less it's going to, potentially the less safe it's going to be, I should say. Yeah, and then the other thing is, you know, if the goal is kind of like speed and stacking as many surgeries as possible on the same trip, you are going to have a bad time. Yeah, you know, I hadn't thought about that, but you're right. It's kind of like, hey, I've got one week. Should I get a hair transplant, come back, then a year later, six months later, fly back to Turkey, get this thing done.

25:22It's like, no, get the hair transplant, the silicone face injections, the tummy tuck and the BBL at the same time. Cause you know, like you're here and you only have two weeks of vacation, you know, don't you want to? So anyway, let's talk about that later. Cause I have more questions about that. But why are so many Americans doing this other than cost, which I'm sure is a big driver. It's a big world out there. And Americans being the number one medical tourists, I probably shouldn't be, but it is surprising to me somehow. Well, a big part of this is an incentive gap. Physicians are just not going to make a killing doing veneers and BBLs in England like you would in the United States.

25:58Okay. There's also the size of the market. America is kind of unique in that it both has a large population and its population is affluent enough to have a robust market. Okay. But China, Russia, Australia, Brazil, they're all kind of big in terms of population and size. Well, Australia, I guess maybe not so much. But don't they have the same level of disposable income that average Americans have? Is that why? I mean, maybe they don't. I have no idea. No, no, not at all. No, they don't. They don't. China, India, that's why America sits in a sweet spot. Large population with disposable middle class income.

26:37I see. As an American, you can move to basically any other country in the world and pay as much but get more. By the way, I don't want people to think I'm absolutely a moron. I know people in China, Russia and Brazil make a little bit less. I just meant relatively speaking, isn't there a huge middle class? But I guess not really. Not like the United States. Not like the United States. America is the like the perfect market for everything for this reason. Yeah. China's got to be on the come up for that, though. And I have sort of seen like China getting more cosmetic surgeries and stuff like that.

27:07But anyway, whatever. That's neither here nor there. Yeah. So in America, a middle class person can save their pennies and see a top end plastic surgeon. You could see a top end domestic surgeon as a plastic surgeon as a, you know. Yeah. You're just going to be paying it off for like two years. Yeah. You're going to be paying it off forever. You're going to be saving up, blah, blah, blah. But you could do it. But then it's like, okay, you know, well, I could do it in Brazil and it's like half a week's wages, you know? Right. Yeah. Yeah. Yeah. Yeah. Most people that is not within their reach. That's a really good example of the like the difference between the American middle class and the Chinese or the Russian or English middle class for that matter.

27:48The point here isn't to be alarmist, though. It's just to let people know that the world of cheap cosmetic surgery abroad can come with some very high costs. So people who do this, do they kind of think they're going to get the exact same surgery at significantly lower cost? Because I assume that they think, hey, it's basically the same thing as the U.S. where I'm just not paying for the USA market. But right out of the starting gate, that's wrong, right? How is plastic surgery abroad different? So even if you trust the doctors to do their job properly, and we're going to get into that part of things later, they are not even dealing with the same raw materials.

28:23Here's a really good example. there are 20 FDA approved injectable fillers. In other countries, it can be as high as 190. And you know what? Maybe all those fillers are fine. I genuinely have no idea. Maybe they are. But what I do know is that 170 of them are illegal to stick in your body in the United States. I've seen other comments about this with fillers specifically because I was doing that dick episode several months ago. And there is stuff that's like better for that, but it's too expensive to get FDA approved, even though it might be better. But the other issue that a doctor here told me about Dr.

29:00Pash at upsizeclinic.com, one of the things that he told me was like, hey, we just don't also have long term data on this. And so the FDA does not like stuff like that. Like they don't want to find out that, oh, yeah, this filler was better. But it turns out you can get necrotic tissue after about 10 years and you're gonna have to have your wiener whacked off like that's not I shouldn't say whacked off cut off. That's not good. Anyway, so for whatever reason, at least some of these fillers are illegal ostensibly because of safety reasons or a lack of long term data or whatever. Sure. And like whatever, maybe in 20 years that we'll have 190 legal fillers in the United States.

29:40And then there's going to be 400 used abroad. But yes, I get your point. American facilities, in addition to government oversight, are regularly inspected by private accreditation bodies, such as the American Association for Accreditation of Ambulatory Surgery Facilities. That's the quadruple ASF. I guess they're branded. They're taking liberties there, but OK. Yeah, they're currently branded as quad A. they require 100 % compliance with very strict standards for staff, equipment, operating procedures, things like that. I don't know what the bar is for the regulatory body, but I would bet money sight unseen that theirs are much higher.

30:23So it's a good, quick and easy way to filter out who the hack jobs are in the United States. Do they have this accreditation? Yes or no? abroad it's far more common to just go shopping for somebody who gives you the green light we talked about the you know the pharmacies earlier stateside when you get a procedure of any kind you're not just paying for the actual procedure you're paying for your little share of a fifty thousand dollar per year compliance officer who makes sure that they get that accreditation by seeing that instruments aren't washed in leftover dishwater before they cut you open with them.

31:05Yeah. For a guy who hates regulations, bro, you're making a pretty strong case for regulations right now. Well, the thing is, people just assume that there's the same kind of regulatory rigor abroad as there is in the in the states. And I'm totally fine with people using whatever medical care they want, but they also need to be aware of what they're getting into. Yeah. Another aspect that people don't understand is the externalization of risk. So you go to a sketchy American doctor and you get a BBL. That sucks. But hey, guess what? He's legally and ethically responsible. There's going to be consequences for this guy.

31:40Right. There are going to be dire consequences for this guy. He's going to jail if he screws this up. Yeah. He's losing his license at best. So nearly three quarters of all medical tourists are not even getting proper follow up after their procedure, which makes the chances of something going wrong much greater. Part of the reason for the follow up is remember we talked about, you know, catching stage zero cancer before it becomes. Yes. Yeah. Catching these little problems that if they go untreated, become very, very big problems. You know, that's interesting you mentioned that because I, as I said on the old Weiner episode several months ago, again, Dr.

32:20Pash over there at UpsizeClinic.com, I should probably verify that URL, but whatever, the dick doctor. I wanted to like sort of do a Louis Theroux and get like something checked for myself or have the procedure myself. I didn't have the procedure, obviously, but he filled this little tiny dent because I was like looking for a reason to have a needle stuck in my penis, just like I talk about on the show. You're welcome, everybody. but even then he was like hey fyi even if i put like this half cc into this little like thumbprint on your wiener like you have to come back in a week and or do a somewhat awkward face time so that i can make damn sure and he made me come in like he was like i want to feel that wiener in my hands you know like he's like i want to make sure that it's not inflamed that there's not the weird stuff happening with the tissue around it and i was thinking to myself when we were doing the notes for this episode, I was like, wait a minute.

33:09What happens if the person who did the original whatever it is to you is in Thailand and you're back in Bristol? You just don't get to do that. Like, and if you go to wherever and you get a BBL, like a really serious one, and you get a gnarly infection, you are not flying back to your medical tourism destination to get it treated. You're going to the emergency room and you're in the UK or in the US or whatever. Yeah, which honestly makes me kind of mad because you and I are paying for that. Yeah, I wondered about that. Right. If they can't afford it, it's going to be Medicare, Medicaid, whatever.

33:44Or it's just insurance companies go, well, we got to raise rates because all this medical tourism and people are coming back with infections. And like we got to we had to pay for that. So everybody else's insurance for getting hit by a car is going up by$100. Yes. Yeah. A recent study found that the average cost for a U.S. hospital for a botched surgery done abroad. It's that specific ranges from twenty six thousand to one hundred and fifty four thousand dollars. The patient saved five thousand bucks. But the U.S. health care system, which is your tax dollars and your premiums, just paid six figures to save their life because they wanted to save a few bucks on a on a BBL.

34:25Yeah, great. So you get a bootleg butt strapped on and the American public has to pay the equivalent of a small suburban house in 1997. Yeah. To make sure that you don't croak as a result. Great. OK. Stay tuned for the the housing crisis episode and we'll explain why you can't get a house for one hundred fifty thousand dollars anymore. Right now, maybe in Compton, you can rent a room in a house for that. You can get a condo for that much these days. Yeah. OK. So even in the best case scenario, the chances of complications are high because after you get the procedure done, you're going to go sit on a plane for 10 hours.

35:00And that causes a condition known as deep vein thrombosis or DVT. You know, I've actually heard about this. And I just remember it's like, oh, if your flight is over X number of hours, you should like do airplane aisle yoga. Yeah. So that the blood doesn't pull something, something in your feet. I don't know. It's one of those silent killers that you can't, you can't really see it until it's too late. And then you're in deep doo-doo. So I think the short version is you get a blood clot usually in your leg because of the way that you're seated or just from being seated, which then breaks up and then goes to your heart and stops it from beating kind of.

35:36So your body treats surgery as a major injury and starts clotting much more easily, like crazy in some people. And then you go sit on a plane in the sky in an economy plus seat for four, if you're lucky, for 14 hours to get home. And the recovery time, as far as I know, for most surgeries before you're safe to fly, cabin pressure, dehydration, sitting for 10, 14 hours, whatever. It's like a month or more. Right. And most of these medical holiday places, they've got you out the door in like a week or less. Yeah. Five to seven days is pretty typical. I've actually never seen the television series botched, but you're missing out.

36:14In the course of researching this, I learned that how soon after did you fly is the question the doctors ask everyone who walks in the door. yeah i am frankly i'm slightly amazed that you of all people have never seen that show it's a funny guilty pleasure to watch like if you're in a hotel and you've got cable which i haven't had since like childhood it's up there with dr pimple popper and 90 day fiance where you're like oh botch is on for the next seven hours just turn it on while we exist in this hotel room and we'll like glance at the tv every seven minutes it's more my wife's thing i'm a bar rescue guy that guy was on my show what is his name again the bar rescue guy that he just like screams at people i don't know his name i just like i've worked in bars and stuff so i i love when he goes into some place that's functionally identical to a place i used to work and screams at people for problems that would have bothered me when i was working there john taffer john taffer yeah that's right yeah yeah he was on the show and he's i was like oh he's a pretty nice guy and then i was but as i was watching bar rescue i was like oh i see he is a like he's basically a gordon ramsay on the show where he's just like screaming at people.

37:21Gordon Ramsay for bars. Right, exactly. Another reminder, by the way, that I need to come hang with your wife at some point and watch trash-ass TV, inane reruns of Bravo shows where people almost kill themselves for, you know, bigger whatevers on their body. I'll make sure to have popcorn and barf bags ready for the both of you. Thank you, I appreciate that. Anyway, yeah, traveling too soon can double or even quadruple your chances of getting thrombosis. Right, and the thing is, you don't get thrombosis just by not flying. I feel like there's a whole set of medical apparatus that legit clinics have on hand so that you don't die because you went to get your boobs lifted someplace.

38:01Yeah, they also have prescription drugs and will recommend that you extend your stay if they think it's medically necessary. A lot of people need more than just rest and hydration after they had a major procedure like breast implants or tummy tuck or whatever. How common are problems when it comes to medical tourism? Because I don't know, I don't hear about this, but I also don't know anybody who does this other than the hair transplant guy that I mentioned before. We don't really know because there's a survivorship bias involved here. I see. So survivorship bias is generally when people focus on success cases over failure cases, which is exactly what I'm doing with this hair transplant guy, because he was fine.

38:39It's like, oh, that's great. If I ever need this, I'm totally going to do that. So you're essentially saying that people are going, hey, I know that this guy did this and everything was fine. It literally what I just said, basically, hey, this guy did it and he was fine. So I'm almost certain to be fine. I'm guessing the CDC or whoever tracks this stuff, FDA, they don't get a notification every time somebody flies to the Philippines to get a facelift or something. Yeah, my old man used to drive drunk like constantly, and lo and behold, he's still walking around alive. It does not make drunk driving a good idea.

39:08Right. There's no rigorous official tracking of this. We do have a little data. A large-scale population study found that roughly 5 % of medical tourists report significant complications upon returning to the U.S. Of those who experience problems, 67 % required medical care back in the United States. Wow. Data from the British Association of Aesthetic Plastic Surgeons or BAPS. Yes, that's really what they're called. They they showed a 94 percent increase in patients needing hospital treatment after overseas surgery over a three year period. OK, but complications, that's kind of vague, right? Is that not just like, hey, this is a little bit red and it's like, oh, OK, here's some ointment and a bandage like that could be required medical care back in the United States after a surgery?

40:01Yes, absolutely. That would be included in complications. Vagueness is doing a bit of work here, and we should address that. In Colombia, for example, which is a popular destination for medical tourism, some high-end clinics report a 6.2 % complication rate, which is actually comparable to benchmarks for U.S. board-certified clinics and physicians. I see. The issue is what are the complications? And that's where we need to get more specific. But there's not a ton of data. Yeah. Like one is, hey, this is a little swollen. The other one is you're going to potentially die from this if you don't go to the ER right now or whatever.

40:39Like you're a little red here. You need some you need a cortisone shot versus like, whoa, that's necrotic tissue. We have to amputate this. Yeah, we have to cut that off. So in the United States, you might get a staph infection. In medical tourism, we see non-tuberculosis mycobacteria, also known as NTM. I love that whenever I have to pronounce something difficult, I put on my radio news reporter voice. Yeah. Otherwise, nobody will understand what the hell you said. So we do appreciate that. Yeah. These are waterborne bacteria found in tap water used to clean instruments at lower end clinics. If your recovery plan involves a beach, a cocktail, and zero legal recourse, maybe balance that out with something sensible, like supporting the sponsors that support this show.

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43:27We've got a subreddit for the show if you want to discuss how terrible I am with other show fans. Actually, that's only 10 % of the threads. Join us over on the Jordan Harbinger subreddit. Now, back to Skeptical Sunday. Shout out to the compliance officer in the United States who does not allow people to just rinse things off in the break room sink and then put them back on the tray for the next person. Oh, my God. Wipe it on a napkin and it's good to go. So these are, in addition to being gross, incredibly hard to treat. They require months of heavy duty antibiotics, and those can cause permanent kidney or hearing damage.

44:06Oh, my gosh. So it's not just like eat a bowl full of pills for a month and you're fine. No, it sounds like IV stuff at that point. IV antibiotics. Oh, my God, dude. I didn't realize. You know, I have heard of hearing damage and, of course, kidney damage from antibiotics. But that's really gnarly. So this, again, as I mentioned, it goes back to regulations and compliance. American hospitals are insanely regulated and thus incredibly clean. There's also a massive bureaucracy just filled with people who, frankly, would probably love to ruin a hospital's day by finding violations. Oh, yeah. The stereotype of Latin law enforcement being essentially freelance has been confirmed by absolutely everybody I know who lives there and has lived there.

44:46And I remember, and again, this is anecdotal, but I'm talking about a lot of show fans write in about this stuff, too. But when I was in Panama and Mexico, first of all, I remember in Mexico, I had to pay the cops to let me go for something I didn't do. Surprise, surprise. And in Panama, when I worked at the U.S. Embassy there, they would pull you over. And the joke was, oh, they must be hungry. It must be lunchtime because they'd be like, you ran a stop sign. And you're like, there's no stop sign here. And they'd be like, I need$10 for that violation. And the running joke with everybody who lived there was just it was lunchtime.

45:18They were hungry and they didn't have any money. and$10 was the price for a decent lunch. And I knew guys that were doing like serious stuff over there because I was working with the narco folks at the US Embassy. As you go up the food chain, the corruption is worse and more expensive. You know, it's not a$10 bribe. It's a trip to Vegas or whatever. So, yeah. Yeah, I've known multiple people who lived in some of the least corrupt countries in South America. And they confirmed that like, you got a problem with your passport or your visa? Well, if you got a hundred bucks, you don't have a problem anymore.

45:49Yeah, exactly. obligatory, okay, fine, it happens in America too, but we're talking about like hospital compliance, medical compliance is like, is crazy here. It's just, mostly we complain about the opposite thing. Like, wait, this thing was left open and in the air in a sterile room for more than a few minutes. And now you have to throw it in the garbage and open something else. Like, that's ridiculous. And it's like, well, there's a 0.01 % chance that something floated and landed on it. We're going to do an heart surgery on a vulnerable person. So like, yeah, we're going to waste a thousand dollars worth of shit because they might die if we don't it's like all right that's probably the best practice yeah i know exactly one person who's ever bribed american cops that's a story for another podcast i assume yeah so there's also the issue where people stack surgeries we said we addressed this a little earlier yeah you fly to thailand you get a procedure because it's cheap and you go hey let's get a bunch while we're there let's get everything done in one trip and then i don't have to pay for another flight so your tummy tuck your breast implants, your lipo, your BBL, your veneers, your Botox, the whole deal.

46:52Yeah, because you're like, I'm already in pain. I'm going to already be taking codeine. I might as well just like get it all knocked out. Yeah. Well, in the United States, surgeons won't do that for the most part because the risk of pulmonary embolism and surgical shock, it skyrockets when you start stacking these. But abroad, it's like, oh, it's the mommy makeover package. You get six different procedures done. Right. And to people like me who don't think deeply about this until right this moment, it totally make sense. Like I got all four of my wisdom teeth removed at the same time. Why wouldn't I also get my butt and my boobs and my lips and my double eyelid surgery and my whatever else implant at the same time?

47:29Because I'm already going to be on pain meds watching Netflix and sleeping all day, like get her done. But no, you're saying the body might kill you as a response to all of these invasive injuries, which like, duh, of course that's going to happen. So other than thrombosis and the dangerous mycobacteria. What are some common complications for medical tourists? And if this is going to get really gross, maybe heads up, y 'all, it might get really gross. It's going to get reasonably gross. Okay. Infections and wound dehiscence. What is that? Yeah, so infections people get. Yeah. Wound dehiscence is when your wounds don't close, they leak.

48:07Oh, bro. I've never even heard that word, dehiscence, but man, is that disgusting. So like just a festering open sore that just... Yes. Come on, man. Oof. Yeah, it's extremely gross. It's also half of all hospital visits for medical tourists after they get back home. So what type of complications? Weeping open wounds that don't close. Lastly, there's hematomas, which is a form of internal bleeding that is going to require another surgery to open it up and drain the blood. Damn, that is all pretty serious. This is not, hey, I have an inflamed incision around the edges. I took three days of antibiotics to clear up a potential infection or like, I don't know, put some ice on it or like you said, a cortisone shot.

48:54I mean, that's really gross. That's really, really gnarly. You don't want a wound that leaks. I mean, that's there's a bit of survivor bias involved in this, because when someone flies to Bulgaria, we'll pick on the post-Soviet world since we've been picking on the third world the whole whole episode. and you get major plastic surgery and nothing goes wrong. We have no idea. But yes, the takeaway from this is that if you do have complications, they are going to be a big deal, if not life-threatening. Yeah, look, TMI, but hey, what else is new? I might as well keep talking about my wang. I had a vasectomy last year or maybe, no, it was even more than last.

49:34It was a couple years ago. And that, very rare, but it got infected. and I had a speaking gig and I could barely walk. Thankfully, the gig was in Hawaii and I told the event hotel and organizer what happened and they basically gave me like the craziest deal ever to stay at the hotel for a week and recover. And it was kind of awesome because I had medical care for something that was relatively minor, but I cannot imagine having that kind of issue someplace else and having to deal with it. I mean, this was like a massive swelling in where the sun don't shine and I went to the ER in Maui. And I'm actually still paying that off because it was like$4 ,000, but I was in no danger of dying from it because I had real medical care.

50:19No, it was serious. And even Kaiser Permanente was like, hey, you probably think we're lying, but this never happens. And the doctor was like, dude, I'm 65 and I've been doing this for my whole career and I've seen like a handful of this. And I was like, well, maybe stop sneezing on the scalpel or whatever. He's just like, no, you just got like terrible luck. This is just straight up bad luck. Buy a lottery ticket, man. Exactly. Exactly. So how many people actually die from complications from surgery? Do we know? The CDC reported 93 U.S. citizens dying following cosmetic surgery in the Dominican Republic.

50:53Again, that's specific to the Dominican Republic and U.S. citizens. And specific to cosmetic surgery, too. So that's a lot sounding from just that narrow place with a narrow niche. And it was just in 2009. Yeah. Yeah. Deaths are increasing in the DR. From 2009 to 2018, the average was about four deaths per year. Between 2019 and 2022, that jumped to 13 deaths per year, with a peak of 17 deaths in 2020. Almost all of these were women with a mean age of 41, and the leading cause was embolisms. jeez i'm guessing that that trend of people dying is not that medical care quality in the dr is going down but that people are going there for more dangerous stuff like bbls probably probably yeah so that's really terrible i wish we had better stats to compare to the u.s because i'd love to get an apples to apples here it's very very difficult to get apples to apples because you have to compare the exact same surgery because like right no one is dying from hair transplants i mean apologies to the one person out there who's like hey my brother died from a hair transplant.

51:59But like, for the most part, people are not dying from hair transplants. But lots of people are dying from BBLs. One thing I do know is that you are not supposed to die at age 41 if you're a healthy woman from elective cosmetic surgery. That's terrible. Yes. Mexico is the number one destination for Americans with over one million visitors annually. You absolutely can find high quality medical facilities in Mexico, but the basement tier clinics can be lethal. In 2023, an outbreak of fungal meningitis linked to cosmetic surgery clinics in Matamoros, Mexico, killed at least a dozen Americans and left dozens more with permanent neurological damage, which I think from, if I'm not mistaken, is probably pretty bad.

52:50I'm going to guess permanent neurological damage is not just like, yeah, I can't feel my fingertip anymore. It's probably like, oh, I can't walk properly anymore because I have had fungal meningitis. Yeah, or I have like symptoms that are functionally identical to MS or something. Yes, exactly. Health authorities in Mexico report that the mortality rate in their medical tourism sector is roughly four to five deaths per 100 ,000 procedures. That doesn't sound like much, but it's significantly higher than international benchmarks for elective cosmetic surgery. The best data we have for the U.S. puts it at one to two deaths per 100 ,000 for elective cosmetic surgeries.

53:37So it's like five times as much. Tijuana, big hotspot for medical tourism. That's 20 % of all surgical fatalities in Mexico. Oh, wow. And that's primarily cosmetic procedures like tummy tucks. They have a fatality rate of five and a hundred thousand, which again, doesn't sound like much depending on where you are, where you're going, couple factors. That could be 10 times the rate it is in the United States. Dang. So, again, doesn't sound like much when you put it that way. But when I say, hey, do you want to have 10 times the risk of dying? People are like, no, of course not. No, thank you. No.

54:17Other thing to remember is that people may be traveling to places that aren't super safe for reasons other than medical procedures. In 2023, four Americans were kidnapped and two of them were killed while they were traveling to Matamoros for a tummy tuck. Look, this is a very real concern. One of my best friends was kidnapped in Mexico. Well, I mean, I was kidnapped in Mexico 26 years ago. You're who I'm talking about. And also, like, my cousin was murdered in Mexico, but he was. Oh, dang. I did not know that. He was doing sketchy shit. So, OK, well, OK, that's like saying my my friend was killed in L.A.

54:54Yeah, he was a crip. Well, OK, not that that makes it OK, but it does increase the likelihood that you're, you know, if you're buying a brick of cocaine, it can. And it's not the same as somebody who's going to the Four Seasons to drink beers at a bar. What about other places? Well, we mentioned Turkey is a hotspot. The British Foreign Office issued a warning after 28 British nationals died in Turkey following medical procedures since 2019. In 2023, dozens of medical tourists contracted botulism poisoning. No. Which is a potentially fatal nerve toxin. Yeah. How do you get that? Stomach Botox. Oh, duh.

55:33Of course. Yeah, it's botulism injections. Right. They went to a weight loss clinic in Istanbul and Izmir. The thing is, again, this is just the tip of the iceberg because there's not much in the way of official records. There's no real rigorous record keeping. We only find out when there's a problem that that requires that scares somebody enough to go to the hospital. I see. OK. There's a couple of things to note as regard fatalities. most official stats only count deaths that occur within the country that they're going for medical tourism or shortly thereafter so if you die of a secondary infection six weeks later in a chicago icu that is probably not going to be counted as a medical tourism death stat sure yeah if you have like a blood infection but yeah you got it because you got staff from them washing the scalpel in the break room during your whatever bbl right exactly yeesh okay yeah bbls are the deadliest cosmetic procedure in human history according to the aesthetic surgery education and research foundation which was a group of surgeons founded specifically out of concerns regarding bbls there's a huge risk of fat embolism that's where fat they accidentally inject fat into a vein and it travels to your heart.

56:51Oh gosh dang dude. I've heard that these are super dangerous if you don't really know what you're doing and they're still dangerous even if you do. In fact I mentioned this at the top of the show the guy who originated the phrase that we use on the show all the time I'm addicted to lip filler. Let me find it. It's one of our soundbites that we use on the recommendation of the week. I am addicted to lip filler. That guy. So he worked in the UK and he gave this mother of five a BBL using filler. I don't totally get how it works, but he's, and he's not a doctor. She died. And so he got arrested and he, you know, posted bail and he was supposed to, in the UK, they call it answer bail, which I guess is just go, you know, to trial after you've, you know, see it to court.

57:33And before he could, he got a BBL with the filler and he died getting that, which is crazy. Like the, I hate to say karma, cause that makes me sound like I'm saying he deserved it or something. But basically, it just came full circle. And he passed away. And it was like days after I licensed that because I had written him and I was like, hey, can I license this? He's like, yes. I was like, here's the document. And he's like, great. And I was like, send me the recording. He sends me the recording. And I was like, hey, could you do this like edit on this thing? And there was no answer. And I was like, ah, this guy, come on, man, you're just going to take my money and run.

58:05It's just a really simple edit. And I never heard from him. And then somebody posted on our subreddit. And they're like, oh, that guy died. And I was like, oh, OK, I guess I won't expect a response to this poor guy. Just to have two people die from BBLs associated with the same person, the odds just can't be good. And again, he's not a doctor, but he didn't do it illegally. I guess you just don't need to be a doctor to do this, which is crazy to me. Yeah, I mean, surgery in general, under the best of circumstances, can be very, very dangerous. But yeah, it's especially true BBLs, though new techniques have made them much safer.

58:38the death rate is now 1 in 15 ,000 for newer procedures, which like people are like, whoa, after hearing 1 in 100 ,000. Right, it's still super dangerous, holy smokes. But it used to be 1 in 3 ,000. Oh my God. Their real-time ultrasound guidance has nearly eliminated the risk of death by fat embolism. But like somebody's got to do that and it's probably not the guy who works at a salon and isn't a doctor. I feel like influencer culture has to play a huge role in this. somebody on Instagram has the work done abroad. They go online. They say it went fine. Don't worry about it. Then they take a couple of pics of their bougie recovery suite.

59:14And it's like, you know, sign up through my link. Right. The testimonials by influencers either conceal or distort the danger. Again, the survivor bias, lack of hard statistics makes it very hard for people to properly assess the risks. And when people find out that the$10 ,000 surgery they wanted forever is$2 ,000 plus a$1 ,000 round-trip ticket abroad, maybe they're going to do due diligence, but maybe they're so excited to get down to business that they get caught up in the moment. They forget that serious illness, disfigurement, even death are very real possibilities. If your surgeon sells vape cartridges out of the front office, we need to talk.

59:54But first, let's talk about the fine products and services that support this show. We'll be right back. This episode is sponsored in part by LinkedIn. Running a small business means every hire matters. A bad hire can cost you time, money, and momentum. A good hire that can help you grow your business. This gives me flashbacks to a nightmare hire in my previous company that really stunted the business. And even talking about it now makes my blood pressure go up. But the right hire is the exact opposite. Somebody who takes ownership, solves problems, and helps the business grow faster. And when you're small, that kind of impact is massive.

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1:00:56Get started by posting your job for free at linkedin.com slash harbinger. Terms and conditions apply. Hey, sweetie, your mother showed me this Carvana thing for selling the car. I'm going to give it a try. Wish me luck. Me again. I put in the license plate. It gave me an offer. Unbelievable. Okay, I accepted the offer. They're picking it up Tuesday from the driveway. I haven't even left my chair. It's done. The car is gone. I'm holding a check. Anyway, Carvana, give it a whirl. Love ya. So good, you'll want to leave a voicemail about it. Sell your car today on Carvana. Pickup fees may apply. Thank you so much for listening to and supporting the show.

1:01:35It is your support of our sponsors that keeps the lights on around here. All of the deals discount codes and ways to support the podcast are on the website, searchable and clickable over at jordanharbinger.com slash deals. Now for the rest of Skeptical Sunday. We aren't talking about a one in a million freak accident. We're talking about a measurable rising body count of people who thought they were buying a lifestyle upgrade and ended up in a morgue because a broker sold them on a clinic that didn't have proper emergency care on site in many cases. One thing I'm dying to talk about is what role, we mentioned this in the intro, but what role organ harvesting plays in medical tourism?

1:02:11Because I might not be as cynical as you, but I'm definitely cynical enough to think that people are for sure flying to Asia to get kidneys that were harvested from Chinese dissidents and Falun Gong members or something like that. I've actually done multiple shows on this in the past, so I know that that's like there's a UN report. This is a real thing. This is not like a weird TikTok conspiracy. Yeah, this isn't like you got drunk and went home with some girl and woke up in a bathtub full of ice and a note saying my kidneys are gone. This is a very real thing. What's the common denominator of all medical tourism?

1:02:44You want to save money or time. You want a cheaper procedure or a shorter weight or both. If people are willing to do this for a nose job or whiter teeth, they're definitely going to want to cut the line or cheap out when it comes to a life-saving organ transplant. Yeah, let's talk about kidneys. I mean, you already sort of stole my thunder with the guy meets a girl at a bar and wakes up in a tub full of ice. But like, what's the real version of this? Is there one? It's honestly, and very sadly, not as different from that as you might think. In America, the average wait time for a kidney is somewhere between three and five years.

1:03:21Wow. There are Chinese websites in English, Russian and Japanese, not Mandarin, mind you, that promise people new kidneys in one to four weeks. Holy moly. Wait, so from three to five years down to you'll wait a month if we really take our time to find a donor. Yes. And there are definitely regulations that make it harder to get organ transplants in the United States. Yes. But the main driver of the wait list is not that the people at the Health Resources and Services Administration who regulate organ transplants, you know, they're not just like being big socialist meanies who want to deny people life-saving treatment.

1:04:00This is a very basic problem of supply and demand. There are tons of people who need kidneys in proportion to the people who are dying and gifting a usable kidney to the next generation. Okay, but what about the idea, and I know I'm playing devil's advocate because I've done shows on this, but what about the idea that there are way more people, way more people in China? So maybe they have more dead people's kidneys to give away and more death row inmates because they have more capital crimes or whatever it is. So here's the thing. Biologically, you cannot schedule a deceased donor transplant weeks in advance unless you know exactly when the donor is going to die.

1:04:38And this is what first tipped off international investigators that something was amiss in the People's Republic of China. Yeah. Yeah. I can see how that might raise red flags. Is there any positive evidence that organs are being harvested in China for the purposes of selling them on the international market? Well, as you know, the China Tribunal, which was an independent people's tribunal who released their findings in 2020, concluded that forced organ harvesting had been committed for years throughout China on a significant scale. Yes. And I can stop playing dumb now, but you can hear more about this on episode 497 with David Kilgore, who did.

1:05:19He was a part of that whole UN China tribunal. It's crazy. Yeah, so China officially claims about 10 ,000 to 17 ,000 transplants per year through their voluntary system. However, researchers using bed counts, staffing, revenue data estimate the actual number is closer to 60 to 100 ,000. The evidence points to Falun Gong practitioners and Uyghur Muslims being used as living organ banks. survivors from re-education camps have testified about receiving frequent medical exams and blood tests that were focused solely on organ health rather than general wellness. Yeah, by the way, Falun Gong is like a meditation.

1:06:06If I say cult, people flip out, but it's sort of kind of like that. But I guess as far as cults go, it's like kind of harmless-ish. Imagine that Buddhism has an offshoot and this offshoot decided that they hate the CCP, the Communist Party of China. And so they're getting persecuted and like they just arrest these people. And also apparently their organs are really good because they're vegetarian and they live a healthy lifestyle full of like semi abstinence and meditation and exercise. So you're getting this is so gross, but you're getting like a high quality kidney or high quality liver from the person that gets arrested and murdered for their corneas or whatever it is.

1:06:42And yeah, I mean, if people are coming back from camps and the numbers don't match and they're getting organ health tests rather than general wellness tests. I mean, it just kind of seems like a pretty big tell. And I'm not alone in thinking that because there's a whole U.N. tribunal that the whole China tribunal kind of came to the same conclusion here. It starts getting really yucky when you introduce medical tourism into the mix in transplant tourism. It really seems like the state views a detainee, which, again, it should be highlighted here, like what gets you thrown in a prison or given a death sentence in China?

1:07:17Sometimes it's a real crime. Other times it's not a crime at all. Well, yeah, it's not a crime in the rest of the world, right? To say like this Xi Jinping guy is a psychopath who's locking us up as part of COVID and this government needs to go like that will get you a death sentence potentially in China. Yes. And it seems like they just view them as like spare parts that they can sell to wealthy tourists. And the people engaged in transplant tourism have, at best, decided not to ask too many questions about where these organs are coming from. I mean, I kind of get it. You know, like, I'm not saying I would do it, although, I don't know, that's a hard thing.

1:07:55Look, you're going to die unless you just don't ask a bunch of questions about where this came from. It's probably not that hard to just ignore your gut when you are literally going to die otherwise. Yeah, and I think that we can be fair in acknowledging the pressure that these people are under, but that does not absolve them of the ethical implications of what they're doing. Both things can be true. Yes. So several countries and some U.S. insurance providers are beginning to refuse coverage for any post-operative care related to transplants performed in what they deem high-risk countries to de-incentivize the practice.

1:08:35The American Stop Forced Organ Harvesting Act moved to sanction individuals and even entire medical systems involved in this trade. Man, sounds like something out of a horror movie, dude. Yeah, it sounds like an Eli Roth movie because it's absolutely grotesque. So, you know, like we said, if you're dying, you're unable to lead a normal life. Yes, people are going to do whatever they have to do to extend their life or get their life back to normal. does not wash their hands of what they're doing, which is coming to buy a living person's organ a month before the Chinese government executes them for having the wrong religion.

1:09:13Why is there no international enforcement against organ harvesting, or is there? Well, international law is a gentleman's agreement. Where's the carrot and the stick for international law? That's true. What about the sanctions you mentioned? I mean, we're not going to sanction China because they're selling a few thousand organs per year, probably. No, because it's a rich mine of slave labor for cheap consumer electronics in the West. And China can absolutely skirt basic human decency on a lot of fronts because the rest of the world has decided that they would rather deal with them for$800 iPhones than do anything about it.

1:09:49Yeah, that's not going to change. Whether it's organ harvesting or human rights violations. No, it's not going to change. You know, it's just the thing that we talked about earlier on a larger scale. People who want a kidney decide not to ask too many questions. The world outside of China has likewise decided not to ask too many questions and to ignore what they do know. So with that said, Mr. I hate laws, I think it's completely appropriate to have laws and private business practices that punish people for getting organ transplants in high risk countries. Yeah, man, this is so tough because I'm trying to think like, would I do it?

1:10:28What if it was my kid? Would I do it? And I'm like, oh, man, this is like it's really tough. It's really tough to make that decision. So, OK, say you've decided you want to go abroad for a procedure. Where would you begin risk management? I think risk management is a really important takeaway here because lots of people are going to just say, I don't care. I'm comfortable with the risk. That's their right to do. But it's important that they be armed with the right tools to make an informed decision. So the place to start, what is the CDC website? I suppose that has medical tourism alerts on it.

1:10:59I mean, I know it does because I just checked it out. All countries are definitely not equal in this regard. So it seems important to choose countries that don't have a frighteningly high rate of complications to the point where the CDC is actually getting involved and telling you not to go there. Yeah, the plastic surgeon associations like the American Society of Plastic Surgeons and the International Society of Aesthetic Plastic Surgery can have information. You can also dig around for malpractice information. But be forewarned, the lack of regulation means a lack of litigation, which means a lack of information.

1:11:36there not being any available evidence for malpractice does not automatically make a surgeon safe it's just the bare minimum i see what are some red flags for people to look out for in the u.s board certified plastic surgeons generally don't offer bogo discounts or you know any kind of deep discount surgery is a medical procedure it's not a black friday door buster so if you see that kind of language at the very least you should be extremely skeptical this is the type of thing where like extremely skilled plastic surgeons do not need to go out with a guy wearing a sandwich board to get customers.

1:12:15They got more than they can deal with. Tossing the sign around outside and dancing with the headphones in. One of those guys on the corner. Yeah, they don't need that. We talked a lot about infections and complications. Some good questions. One very good question to ask is, if I have a complication, which hospital do you have admitting privileges at? If they say they handle everything in-house, That is a giant screaming red flag. You want a surgeon who can get you into a fully equipped, accredited hospital if things go south. Yeah, you would think so. So if a broker says you can fly home five days after a major procedure like a tummy tuck or a BBL, it sounds like they're prioritizing their bed turnover over your life and recovery.

1:12:53And a safe recovery usually requires at least, at least, at least, at least two to four weeks on the ground before a long haul flight to mitigate thrombosis risks. And sometimes it's longer than that. You should check for international accreditations like JCI, which is Joint Commission International. We mentioned the International Society of Aesthetic Plastic Surgery. If you can't verify their license on an official government registry, they do not exist. We live in a world where we're told we can hack almost anything. We can hack our productivity and our sleep and our investments. It's incredibly tempting to believe we can hack the high cost of American health care by simply getting on a plane.

1:13:33Yeah, and you might be hacking your wiener off if you do. That's right. I would be very, very careful. Speaking of life hacks, how about chopping off that extremity? Yeah. Yeah. The global medical market is not a loophole. It is a trade-off. And you may decide that's fine. That's your decision to make. But when you see a price tag that's 70 % lower than the domestic average, you are not just saving money on some nebulous overhead. You're paying for the removal of the safety net that exists. It's a double-edged sword. The regulations are very, very burdensome in some ways, but they also mean that fewer people die.

1:14:12And you are also trading away your right to legal recourse and your surgeon's accountability for follow-up care and possibly even access to emergency services in the event that something horrible happens on the operating table. I do not want to have a cardiac arrest on an operating table in Bolivia. No, I don't want to have one anywhere. But if I have one somewhere, I hope it's next to the Cleveland Clinic or the Mayo Clinic. Dude, I don't want to have one at the hospital down the street from me. Right, right, right. You know? Yeah, I want only the best guys on the job. All right. As we explored with the grim reality of transplant tourism, there's an extremely ugly side to medical tourism in general.

1:14:53Whether it's a bargain BBL in a strip mall clinic or a scheduled kidney in a black box hospital system, the results are the same. The patient becomes a customer and the body becomes a commodity. Thanks to Nick Pell for helping us lift the bust and the buttocks of our medical knowledge. And thanks to you for listening. Topic suggestions for future episodes of Skeptical Sunday to me, Jordan at JordanHarbinger.com. Advertisers, deals, discounts, ways to support the show, all at JordanHarbinger.com slash deals. I'm at JordanHarbinger on Twitter and Instagram, where you can also connect with me on LinkedIn.

1:15:26This show is created in association with Podcast One. My team is Jen Harbinger, Jace Sanderson, Tata Sadlowskis, Robert Fogerty, Ian Baird, and Gabriel Mizrahi. Our advice and opinions are our own, and I'm a lawyer, but I'm not your lawyer. Also, we, of course, we try to get these as right as we can. Not everything is gospel, even if it's fact-checked. So consult a qualified professional before applying anything you hear on the show, especially if it's about your health and well-being. Remember, we rise by lifting others. Share the show with those you love. And if you found the episode useful, please share it with somebody else who could use a good dose of the skepticism and knowledge we doled out today.

1:16:00In the meantime, I hope you apply what you hear on the show so you can live what you learn. And we'll see you next time. You probably don't picture drug cartel operations running through rural America, but that's exactly why they're so hard to stop. Mariana Van Zeller breaks down how these networks hide in plain sight using everyday systems and small-town blind spots to stay one step ahead. I've been covering the cartel for many years now, And I sort of wanted to do a story about cartel presence in the U.S. And once we started researching it, I realized that actually the story should be about all the things that we don't know about cartel presence in the U.S., including the fact that they're in small-town America.

1:16:38So one of our first shoots for that episode was in Georgia. And we started with a murder investigation of this woman who was tortured, and they cut off her fingers and then eventually killed her. And she was killed by the cartel. and it was in the middle of nowhere in Georgia. And then we followed the investigation and Jiham realized that they're everywhere and particularly like to operate in small-town America. Less law enforcement, easier to hide the drugs and have their distribution networks. You know what's so interesting about that story is that in order to get access to the cartel in the U.S., we actually had to go down to Mexico and gain permission and have them say yes.

1:17:17Because a lot of these groups have people that work for them in the U.S. Obviously the U.S. is the end goal where they're sending their drugs. And so eventually he said, OK, we've got you. And it was all set up and we were supposed to meet them in Minnesota. We get there and then we waited and waited and waited for days. I'm like, I never showed up. I want people to see many of these traffickers. Again, we do not condone what they do. It's difficult to even empathize. But the majority of the people that I talk to are people just like you and me that don't have the opportunities or the luck that we have.

1:17:47I try to always do my job as a journalist, which is hold people accountable. If you want to hear how cartels hide in plain sight, check out episode 1302 of The Jordan Harbinger Show.

1:18:20something heavy that no one else could see, this song is for you. Check out Monsters wherever you listen to your music and follow me on social media at Harrison underscore Prentice Music. Thanks for listening. I sleep with lights on these days. What is that? Oh, yeah, it's a World Cup holder. Like the soccer tournament World Cup? For the world. Fits every car, holds every cup. It has a Carvana logo? Carvana made it. They buy and sell cars, so they made a car cup holder. So, uh, got any good cups lately? Used to, just couldn't figure out where in the world to put them. The World Cup Holder, brought to you by Carvana, proud sponsors of the World Cup Holder.

1:19:00Sign up today to win yours at cup-holder2026.com. Not authorized or endorsed by FIFA, not a real product, for parody and fair use purposes only. Hey sweetie, your mother showed me this Carvana thing for selling the car. I'm gonna give it a try. Wish me luck. Me again. I put in the license plate. It gave me an offer. Unbelievable. Okay, I accepted the offer. They're picking it up Tuesday from the driveway. I haven't even left my chair. It's done. The car is gone. I'm holding a check. Anyway, Carvana, give it a whirl. Love ya. So good, you'll want to leave a voicemail about it. Sell your car today on Carvana.

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