1348: Medical Tourism | Skeptical Sunday

1348: Medical Tourism | Skeptical Sunday

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Jordan Harbinger: [00:00:00] Welcome to Skeptical Sunday. I'm your host, Jordan Harbinger. Today I'm here with Skeptical Sunday co-host, writer, and researcher Nick Pell. On The Jordan Harbinger Show, we decode the stories, secrets, and skills of the world's most fascinating people and turn their wisdom into practical advice that you can use to impact your own life and those around you.

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Just visit [00:01:00] jordanharbinger.com/start or search for us in your Spotify app to get started Today on the show, you might have seen episodes of Botched where Dr. Dubrow and Dr. Nassif have to piece somebody back together after a bargain surgery went south. In fact, a contributor in a way of our own show had to deal with that at one point.

We'll get into that later. Usually, that story starts with a flight to another country and a price tag that seemed a little bit too good to pass up. On today's Skeptical Sunday, we're talking about medical tourism. On the surface, it's the ultimate life hack, right? You fly to Turkey, you fly to Mexico, you get a Brazilian butt lift or a new set of veneers for 70% off, and you recover on a beach somewhere, maybe on your stomach if you got the BBL.

But it's the dream sold by influencers and reality TV alike. But behind the filtered recovery photos is a massive global industry that relies on wage arbitrage and a total lack of legal oversight. When you leave the country for a procedure, you're also leaving behind malpractice laws, insurance, and safety regulations.

You're essentially betting your [00:02:00] life that nothing goes wrong because if it does, there's no undo button and no legal recourse. Today, we're talking at the true cost of these savings. We'll break down why the complications are often socialized by US hospitals while the profits stay private. We're also going to take a look at the darkest edge of this marketplace where the lack of transparency leads to genuine human rights horrors, like forced organ harvesting.

It's a look at what happens when the human body becomes just another link in the global supply chain. Here today to help me separate the cosmetic from the chaotic is writer and researcher Nick Pell. Nick, how many cc's did you get for your Brazilian butt lift?

Nick Pell: Zero. I just got a ton of tattoos, but my wife really wants a ton of procedures, so saving my pennies for that.

Jordan Harbinger: Yeah. Every single episode of Skeptical Sunday contributes to what, your, your Get My Wife Freakishly Large Boobs fund?

Nick Pell: Yes. That is- ... actually exactly what she wants, and freakishly- Okay ... large is a good way of putting what she wants.

Jordan Harbinger: Okay.

Nick Pell: My wife's desire [00:03:00] to transform herself into a walking advertisement for a Beverly Hills plastic surgeon is kind of why I know a lot about these procedures, and we've actually had conversations about exactly why she will not be flying to Turkey to get 1,000 cc's of silicon put in her boobs.

Jordan Harbinger: Well, that's weird though because we both know you guys love a bargain.

Nick Pell: We do love a bargain, but I like having a living wife better.

Jordan Harbinger: Sure.

Nick Pell: Even if you trust a doctor in Bolivia, which by the way, I don't There's tons of other issues you're going to run into getting plastic surgery abroad in the best case scenario.

Jordan Harbinger: Yeah, I think it's important to point out that there are tons of countries where you can do medical tourism that's super safe. You know, I can go to Taiwan and get probably around 20 grand worth of health checks for, like, $4,000. I know that's still expensive, but stuff like scans for early stage cancer, tons of blood work, MRIs, CAT scans, CT scans, whatever, tons of exploratory [00:04:00] stuff.

I mean, I've, I had, like, a thyroid scan and they're like, "You have little things in there that we've got to check up on in a year or two," because that might be nothing. It's probably nothing. But it could also be, like, stage zero cancer, basically. And so, like, I'm going back this year, and if it's bigger, they're going to do something about it, and if it's not, then they just let it go.

And the, the truth is, most people have something like that. You just find out about it when it's all over your body and you have to do chemo or you're going to die. So I'm like, "Let me get ahead of that." A- and Taiwan has the third-best healthcare system in the world, at least on the ranker that I took a look at.

So it's not like I'm not flying to a Caribbean island to get a dick implant. All right, anyway, what are some of the differences between the American healthcare system and healthcare systems abroad just generally, besides the fact that ours is super expensive and everybody complains about it? I'm not

You know, you know what I'm talking about.

Nick Pell: Yeah. Malpractice laws is the big one. Laws in general, uh, it's a pain because malpractice insurance and litigation drive up the cost of American medical care, as [00:05:00] I'm sure you know, because I'm sure you've had heard doctors talk about it.

Jordan Harbinger: Sure.

Nick Pell: But they also mean that you have a recourse if things go wrong.

So if you're getting 1,000 cc's of silicone pumped into your chest in Bolivia, there's a lot of things that can go wrong.

Jordan Harbinger: Right, and people aren't thinking about that when they see somebody got a BBL in Thailand for 1,000 bucks using basically a Groupon they found on Instagram.

Nick Pell: In fairness, I'm sure tons of people go abroad, save a few bucks, get the exact same procedures they wanted, and they're fine.

But you're taking a massive risk. The world's best doctors are in the United States. I'm not really aware of anybody who disputes this. This is especially true when you're talking about unnecessary elective cosmetic procedures. Countries with single-payer and other forms of not-for-profit healthcare just do not have the same robust market for doctors that we do in the good old US of A.

Before people jump on me for this, according to [00:06:00] Newsweek, out of the top 10 hospitals in the world- Four of them are in the United States.

Jordan Harbinger: Okay.

Nick Pell: Johns Hopkins, Mayo Clinic, Mass General, and the Cleveland Clinic. Doctors in the United States perform roughly 22% of all global cosmetic surgeries, 7.4 million procedures annually.

And when it comes to plastic surgery, volume correlates heavily with skill. American doctors are just getting their reps in in a way that doctors abroad are not.

Jordan Harbinger: Yeah. Okay. So w- I want to also just sort of say, like, we're not saying, "Hey, doctors in Turkey and Thailand are bad and they're going to kill you."

This is, like, exclusively cosmetic surgery that you don't need, and the skill of the, the health system as a whole, not like the doctor that you are or your cousin is or you'd used in Bangkok is automatically terrible. I don't want to get emails about that, because that's like, that's like not what we're- And

Nick Pell: the risk of getting an MRI is, like, zero.

Jordan Harbinger: Right. Yeah. Like, if you're getting an MRI in Turkey, it's [00:07:00] pr- well, fine, unless they're bashing you over the head with a hammer or something when they put you in the machine. Like, it's fine. We're talking about, uh, a clinic in... I mean, the, the thing is there's, like, guys in Mexico doing five BBLs a day, and they're getting their reps in, Nick, but I worry that some of them might not actually be doctors, and that's kind of where I'm going with this.

Not like, oh, Mexican doctors aren't real doctors, but, like, no, this person is a guy who dropped out of nursing school in the United States and went, "Screw it. My cousin runs a clinic in Tijuana, and he can show me how to do, inject silicone into somebody's butt. This isn't that hard." And they're doing a bunch of those.

But yeah, that's not because they're qualified. It's because there's nobody stopping them. So do we know how many people are engaged in medical tourism every year?

Nick Pell: The Medical Tourism Association estimates roughly 14 to 22 million people a year travel internationally for medical care. Medical tourism is valued at approximately [00:08:00] 40 to 48 billion in 2025 and is currently growing at between 15 to 20% annually.

As of 2024, 2025, estimates suggest that over one million Americans are again crossing borders for medical reasons.

Jordan Harbinger: I can't even believe there's a Medical Tourism Association. What is that for? Advocacy group, I guess?

Nick Pell: It's a nonprofit trade organization-

Jordan Harbinger: Okay ...

Nick Pell: dedicated to medical tourism and the international patient industry, and it's headquartered in, drum roll-

Jordan Harbinger: Yeah

Nick Pell: West Palm Beach, Florida.

Jordan Harbinger: Zero surp- I was going to guess Miami, but I gu- I think West Palm Beach is, like, basically that. But, like, yeah. Okay. So what are the biggest des- what are the biggest destinations for medical tourism?

Nick Pell: Mexico gets over a million international patients a year. Most of these are from the US and Canada.

Thailand is getting over three million annually. That's the big spot in the Asia-Pacific region. Turkey sees hundreds [00:09:00] of thousands of visitors a year, specifically for hair transplants. They do about 1,500 of these every day.

Jordan Harbinger: Wow.

Nick Pell: Stomach Botox, weight loss procedures is another big one. And South Korea reached a record high of 1.17 million foreign medical tourists in 2025.

Jordan Harbinger: Someone close to me went to Turkey for a hair transplant, and I have to say, they crushed it. It was really, really well done, which I guess shouldn't be a surprise when there's 1,500 per day being done over there. That's, like, a chunk of their economy. That's crazy. What are the main procedures people are looking for?

Hair transplants obviously is serious, at least in Turkey, but I find it hard to believe that three million people are getting, I don't know, double eyelid surgery in Thailand every year.

Nick Pell: Surprisingly, the big one is dentistry. It's over half. 55% of medical tourism trips every year are for dentistry.

Cosmetic [00:10:00] surgery is somewhere between 17 and 24% of the industry, and the rest is taken up by cardiovascular surgery, fertility treatments like IVF, and orthopedic surgery.

Jordan Harbinger: We're talking about not just cosmetic surgery for medical tour- I just, I don't know why. I guess I assumed all of it was just like, "I, I want a tummy tuck and it's expensive."

So these procedures, it seems like the people would skew older, specifically the cardio and orthopedic surgery. I mean, I don't know a lot of 25-year-olds or 30-year-olds going to get a orthopedic surgery done.

Nick Pell: Well, it depends on what you mean by older, because I got some bad news for you about my age and your age.

Jordan Harbinger: Yeah,

Nick Pell: shoot. We're, we're ol- we're older people now. Here,

Jordan Harbinger: lay it out, lay it on me.

Nick Pell: So baby boomers are the wealthiest age cohort in America, so they're more likely to just have it done down the street here in America. The majority of medical tourists are between 40 and 60, and they want stuff like hip and knee replacements on the cheap.

There's been a surge in people 30 to 45 seeking surgery abroad. [00:11:00] That's the prime demographic for lipo, BBLs, veneers, hair transplants. Also, it's weird that those four things are lumped in together, because two of them are, like, you might die, and the other two are, like, you might have an ugly hairline.

Jordan Harbinger: Yeah.

Yeah, at worst.

Nick Pell: Yeah. Yes. So what you're seeing is Gen Xers who are just too broke to get medically necessary surgery done domestically, and millennial digital natives who don't think any of this is at all suspect because they heard about it online and, you know, they trust influencers. In fact, their problem is that they're going to be more credulous of whatever it is that the influencers have to say than traditional advertising.

Jordan Harbinger: So seniors are mostly not engaging in medical tourism because they don't need to?

Nick Pell: They are, just not to the same degree. Uh, like I mentioned, like boomers are the wealthiest age cohort in America, but a lot of them are on fixed incomes. So with the cost of healthcare [00:12:00] constantly on the rise, they need to find ways to get today's procedures done at yesterday's prices.

So they fly to Costa Rica, they fly to Panama, Thailand, and that's where they get their dental overhauls or long-term cardiac care. There's also tons of people from countries like the UK and Canada with socialist medicine who just don't want to sit on a waiting list forever, so they go somewhere with a strong private sector or a stronger private sector, anyway, that's also way cheaper than where they live.

The one common denominator among age groups and nationalities is that it's mostly women. It's 60% of all people engaged in medical tourism. But Turkey got such a name for doing hair transplants, as we mentioned, that 90% of people who are going to Turkey for medical tourism are men.

Jordan Harbinger: Yeah, okay. That kind of makes sense.

Do we have any stats on men versus women when we're talking about cosmetic procedures versus more necessary procedures? I don't know, I guess I just assumed [00:13:00] other than hair transplants it was mostly women getting, you know, fake boobs, for example.

Nick Pell: Well, we don't have anything specific, but we do know that the overwhelming majority of people getting cosmetic surgery are women.

That's north of 80%. It's fair to infer that this would skew harder towards women if we were only talking about cosmetic surgery.

Jordan Harbinger: What's the history of this? How did countries like Thailand and Turkey even get these industries in the first place? It seems so random, I guess. I don't r- uh, like, I, I don't...

How does any of this happen, really?

Nick Pell: Well, globalization also creates global labor arbitrage. This is where companies decide labor is cheaper somewhere else, so they build their business where labor is cheap.

Jordan Harbinger: Okay. So hence why cars are not made in Detroit anymore.

Nick Pell: Correct. But labor arbitrage doesn't just apply to manufacturing.

Individual consumers might decide that a product or a service isn't something they want to pay American labor prices for. But- They're going to pay Turkish and Thai labor prices for it. That they're comfortable doing. I mean, [00:14:00] the last three companies I've worked for, the entire admin team is in the Philippines.

I think it may even be the last four, like admin teams for e-com businesses are like always in the Philippines or Indonesia or, you know, Belarus or somewhere.

Jordan Harbinger: Malaysia.

Nick Pell: Yeah.

Jordan Harbinger: Yeah.

Nick Pell: Regulation and accreditation might also be lower somewhere else, and that's going to drive down the price because it's just not as hard or expensive to get going.

Jordan Harbinger: What's the deal with the medical tourism brokers? I've seen these advertising online as well.

Nick Pell: Ha. The travel agents no one knew existed. They're some- Exactly. Yeah, they're sometimes called facilitators, but they might as well be called salesmen. So let's say you want to, you know, go to Turkey and get veneers.

How are you going to do that?

Jordan Harbinger: Well, that's a good question because I have no idea, but I, I would probably start googling hospitals in Turkey with English websites or just google like Turkey veneers and pick one that didn't only have Turkish as a result. This, this already sounds like a [00:15:00] really bad idea, and I would probably try to find somebody who can help me, yeah.

Nick Pell: So nobody knows how to go get veneers in Turkey-

Jordan Harbinger: Okay ...

Nick Pell: as it turns out.

Jordan Harbinger: No patients, yeah, nobody out of nowhere, yeah, the patients know.

Nick Pell: Right. Well, there are people. They're the brokers.

Jordan Harbinger: Right.

Nick Pell: So there's tons of moving pieces involved, and the brokers, they fill the gap.

Jordan Harbinger: And this is legal? I feel like that's...

We don't have that here.

Nick Pell: No, we don't. It's not legal in the United States. There are specifically laws against kickbacks. You cannot pay someone for referrals in the United States, but as anyone who's ever been to a Mexican pharmacy knows, I think someone may be listening right now who has-

Jordan Harbinger: Uh-huh ...

Nick Pell: this is not the case in other countries.

Jordan Harbinger: No, I mean, I, I've definitely never purchased contraband in a Mexican pharmacy that the doctor who works next door told me to go to. That's never been anything I've done as a child-

Nick Pell: Yeah, and I- ... up to age 20 ... I bet it wasn't the same thing I get off the dark web either.

Jordan Harbinger: Right.

Nick Pell: In a lot of other countries, paying for [00:16:00] referrals isn't just legal and allowed, it's completely normal.

So if you've been to Mexico, you know that if you want a drug from a pharmacy, lo and behold, wouldn't you know it, there's a doctor right next door to the pharmacy who's going to diagnose you with whatever your heart desires. And you're going to walk over to that pharmacy with the script that he just gave you after, you know, you told him what you wanted a script- Wanted.

Yeah, right.

Jordan Harbinger: Right.

Nick Pell: And you're going to get it. You know, like basically anything short of Oxycontin. They're not going to give you opioids, but other than that they'll give you anything.

Jordan Harbinger: Right. I feel like my testosterone is really low even though I'm 20 years old and I work out all the time. I definitely need some help with that.

Okay.

Nick Pell: Yeah.

Jordan Harbinger: Go to the vet next door and make sure, get this particular thing from a vet. I remember when I lived in Mexico, I wasn't into that particularly, but I, there were tons of guys at the gym and I remember being like, "Let's go eat." And they're like, "Hold on, we've got to go do something." And we would walk to literally [00:17:00] like a veterinarian and they would be like, "Oh, uh, yeah, I need something for my horse."

And the guy would just start laughing and like hand over a big ass bottle of, I don't know, horse steroids, I guess. Trenbolone. And we would just be like, "Cool, thanks."

Nick Pell: Trenbolone.

Jordan Harbinger: Yeah, it was like Equipoise, something called Equipoise or something. It was like good for- I think

Nick Pell: Equipoise is Trenbolone. Um-

Jordan Harbinger: Oh, maybe.

Yeah, yeah. '

Nick Pell: Cause they all have like- Six different names. And maybe it's not, I don't know. But, uh-

Jordan Harbinger: It is boldenone-

Nick Pell: Yeah ...

Jordan Harbinger: undecylenate, a veterinary anabolic steroid used primarily to treat debilitated horses, improving appetite and weight gain. Is an androgenic steroid. Its function is to enhance muscle growth and red blood cell production.

Side effects include overt aggressiveness, not for human use. Okay, well, that explains a few things with these guys, you know- Yeah ... getting into fights with d- hot dog vendors essentially for absolutely no reason, um, and each other, uh, all the time. Yeah. Anyway, so okay, tell me about the brokers.

Nick Pell: The brokers work on commission.

That comes with a whole host of ethical issues. [00:18:00] They get anywhere between 10 to 40% of what your procedure costs.

Lip Filla Clip: Okay.

Nick Pell: And that means not only might they push you towards procedures you don't actually need or want, it also means that they're going to send you to the clinic with the highest commissions, not the ones with the lowest infection rates or the ones who are the best at doing what you want or need.

Jordan Harbinger: Yeah.

Nick Pell: They're also often partnered with influencers who they use to market their services to a broader audience.

Jordan Harbinger: Yuck. Yeah, okay. All of the sudden, the infection factory looks like a med spa in Beverly Hills, and someone's, like, swimming in a pool after their liposuction or something, and they're like, "This place is great.

The food is amazing." And I've, I can just... I've seen these reels or whatever where they're, like, laying out, and I'm like, "Didn't you just get, like, s- whatever, stomach Botox?" You know? And they're just, like, hanging out and showing it off. I never even figured that they were getting paid, but also... B- an- I mean, I figured they were getting paid, but I, I didn't also think that there was a broker that they [00:19:00] were sending people to that was also getting...

I mean, that just seems... This is a recipe for disaster.

Nick Pell: Yes. So they're not going to show you the person who got MRSA-

Jordan Harbinger: Right ...

Nick Pell: and spent weeks fighting that infection off. I mean, why would they? By the time you realize that what you thought was a luxury recovery suite is actually a filthy old hotel with no medical staff, you're out thousands, you're in a foreign country, and you can't move.

Jordan Harbinger: Yeah. I mean, some of these hosp- ... I've seen some of the H- Thailand and, and Taiwan hospitals as well, and they're super nice, but you don't necessarily know what you're getting when you book this thing sight unseen, right, with the AI photos and stuff. So how does one become a broker?

Nick Pell: They like to call themselves case managers or health coordinators, and you become one the same way you become a nutritionist.

You start calling yourself one.

Jordan Harbinger: I see. Okay.

Nick Pell: I'm a nutritionist.

Jordan Harbinger: Congratulations?

Nick Pell: Yeah, exactly. Like, yeah.

Jordan Harbinger: Okay. Yeah.

Nick Pell: Um, I'm a nutritionist now because I said I am one. Is there's, there's no official procedure.

Jordan Harbinger: Yeah. [00:20:00] What do you call it? A- accreditation or whatever.

Nick Pell: There's no licensure. Certification. There's no certification.

You just wake up one morning and declare yourself to be one, and lo and behold, you are.

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Small detail, but it showed that they really were paying attention. ConciergeMD works around your schedule and keeps everything connected under one roof. Go to conciergemd.com/jordan and use code Jordan. Don't forget about our newsletter, Wee Bit Wiser. It's a bite-sized gem from us to you every single Wednesday, asterisk, most Wednesdays.

Under two-minute reads, really, really fun to write, really, really fun to read according to y'all. So go to jordanharbinger.com/news. That's where you can find it. Now, back to Skeptical Sunday So throwing your hat in the ring being the whole requirement. Yeah. I- that's kind of, kind of like starting a podcast.

Okay. So brokers, they also try to pitch it like a vacation. I've seen this. They'll encourage you to like, you know, see the sights, and that to me seems a little dangerous depending on what kind of procedure you had. I mean, I guess my point is the broker is also not a doctor. A doctor [00:23:00] would... I don't want to speak for all doctors, but I'm going to go ahead and say a doctor's never going to tell you to hoof it around the Istanbul farmer's market less than a week after you had a bunch of invasive surgeries done on your body.

Nick Pell: No, a- and you can absolutely do medical tourism that's relatively safe. Dental care, it can go wrong, but like, the how wrong can it go matters here But these elective procedures from someone who knows what they're doing and does follow-up, you know, that's the other piece of the puzzle. Like you mentioned Taiwan, like Taiwan has an excellent medical system.

Other countries are not known for having excellent medical systems.

Jordan Harbinger: 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.

Nick Pell: 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.

Jordan Harbinger: 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 [00:24:00] transplant, come back, then a- a year later or six months later fly back to Turkey, get this thing done?" It's like, no, get the hair transplant, the silicone face injections, the tummy tuck, and the BBL at the same time because you know, like you're here, and you only have two weeks of vacation.

You know, don't you want to... So anyway, w- but let's talk about that later because 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.

Nick Pell: Well, a big part of this is an, 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.

Jordan Harbinger: Okay.

Nick Pell: 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.

Jordan Harbinger: Okay, but China, Russia, Australia, Brazil, they're all kind of big in terms of population [00:25:00] and size. Well, Australia, I guess maybe not so much. Uh, but- Yeah ... 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.

Nick Pell: No. Okay. No, not at all.

No, they don't. They don't. China, India, that's the... why America sits in a sweet spot, large population with disposable middle class income.

Jordan Harbinger: I see.

Nick Pell: As an American, you can move to basically any other country in the world and pay as much but get more.

Jordan Harbinger: 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.

Nick Pell: Not like the United States. Not like the United States. Okay. America is the like, the perfect market for everything for this reason.

Jordan Harbinger: 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. But anyway, I... whatever, that's neither here nor there.

Nick Pell: 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 [00:26:00] domestic surgeon, as a, a g- plastic surgeon, as a, a, you know-

Jordan Harbinger: Yeah, you're just going to be paying it off for, like, two years instead

Nick Pell: of- Yeah, you're going to be paying it off forever.

You're going to be saving up- Right ... 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?

Jordan Harbinger: Right, yeah.

Nick Pell: 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.

The 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.

Jordan Harbinger: 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 US where I'm just not paying for the USA markup."

But right out of the starting gate, that's wrong, right? How is plastic surgery abroad different?

Nick Pell: So even if you trust the doctors to [00:27:00] 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. Here'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.

Jordan Harbinger: 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 just too expensive to get FDA approved even though it might be better.

But the other issue that a doctor here told me about, Dr. Pash at upsizeclinic.com, uh, 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 [00:28:00] can get necrotic tissue after about 10 years, and you're going to have to have your wiener whacked off."

Like, that's not... Probably shouldn't say whacked off. Cut off. Uh, that's not good. Uh, 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.

Nick Pell: Sure, and, like, whatever. Maybe in 20 years the... we'll, we'll have 190 legal fillers in the United States.

Jordan Harbinger: And then there's going to be 400 used abroad. Yes. But yeah, I get your point.

Nick Pell: 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 AASF. I guess they're branded-

Jordan Harbinger: They're taking liberties there, but okay.

Nick Pell: Yeah, they're currently branded as Quad A. Um, they require 100% compliance with very strict standards for staff, equipment, operating procedures, things like that. I [00:29:00] don't know what the bar is for the regulatory body, but I would bet money sight unseen that theirs are much higher. So 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 $50,000 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.

Jordan Harbinger: Ugh. Yeah, for a guy who hates regulations, bro, you're making a pretty strong case for regulations right now.

Nick Pell: Well, the thing is, people just assume that there's the same kind of regulatory rigor abroad as there is in the, in [00:30:00] 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.

Jordan Harbinger: Yeah.

Nick Pell: 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 n- hey, guess what? He's legally and ethically responsible. There's going to be consequences for this guy.

Jordan Harbinger: Right.

Nick Pell: They're going to be dire consequences for this guy.

Yeah,

Jordan Harbinger: he's going to jail if he screws this up. Yeah.

Nick Pell: 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-

Jordan Harbinger: Yes

Nick Pell: yeah, catching these little problems that if they go untreated, become very, very big problems.

Jordan Harbinger: You know, that's interesting you mention that because I, as I said on the [00:31:00] old, uh, wiener episode several months ago, again, Dr. Pash 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 myse- or ha- 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 so I could talk about it 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 FaceTime 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 cr- 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.

What happens if the person who did the original whatever it is to you is in Thailand and you're back in Bristol?" You [00:32:00] just don't get to do that. Like, and, 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 in your, in the UK or in the US or whatever.

Nick Pell: Yeah. Which honestly makes me kind of mad because you and I are paying for that.

Jordan Harbinger: Yeah, I wondered about that. Right, if they can't afford it, it's going to be Medicare, Medicaid, whatever, or it's just insurance companies go, "Well, we've got to raise rates because all this medical tourism and people are coming back with infections, and like we've got to, we had to pay for that, so everybody else's insurance for getting hit by a car is going up by $100."

Nick Pell: Yes.

Jordan Harbinger: Yeah.

Nick Pell: A recent study found that the average cost for a US hospital for a botched surgery done abroad, it's that specific, ranges from 26,000 to $154,000. Whoa. So the patient saved 5,000 bucks, but the US healthcare system, which is your tax dollars and [00:33:00] your premiums, just paid six figures. To save their life because they wanted to save a few bucks on a, on a, a BBL.

Jordan Harbinger: Yeah, great. So you get a bootleg butt strapped on, and the American public has to pay the equivalent of, of a small suburban house in 1997- Yeah ... to make sure that you don't croak as a result. Great. Okay.

Nick Pell: Stay tuned for the, uh, the housing crisis episode, and we'll explain why you can't get a house for $150,000 anymore.

Jordan Harbinger: Right. No. Uh, maybe in Compton you can rent a room in a house for that ... Yeah. You can get a condo for that much, uh, these days. Yeah. Okay.

Nick Pell: 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, and that causes a condition known as deep vein thrombosis or DVT.

Jordan Harbinger: 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-

Nick Pell: Yeah ...

Jordan Harbinger: so that the blood [00:34:00] doesn't pool 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 wa- 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. So your body treats surgery as a major injury and starts clotting much more easily, g- like crazy in some people.

And then you go sit on a plane in the sky in a economy plus seat for for- 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 to 14 hours, whatever, it's like a month or more, right? Yeah.

And most of these medical holiday places, they've got you out the door in, like, f- a week or less.

Nick Pell: Yeah, five to seven days is pretty typical. I've actually never seen the television series Botched, but-

Jordan Harbinger: Oh, you're missing out.

Nick Pell: In the course of researching this, I [00:35:00] learned that how soon after did you fly is the question the doctors ask everyone who walks in the door.

Jordan Harbinger: 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 Fiancé, where you're like, "Oh, Botched is on for the next seven hours?

Just turn it on while we exist in this hotel room, and we'll, like, l- glance at the TV every seven minutes." It's

Nick Pell: more my wife's thing. I'm, I'm a Bar Rescue guy.

Jordan Harbinger: That guy was on my show. What is his name again? The Bar Rescue guy that he just, like, screams at people. I

Nick Pell: 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've bothered me when I was working there.

Jordan Harbinger: Jon Taffer- Jon Taffer ... is his name. Yeah. That's right.

Nick Pell: Yeah, yeah,

Jordan Harbinger: yeah. Yeah, he was on the show, and he's... I, 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. [00:36:00] He is a, like, he's basically a Gordon Ramsay on the show where he's just, like, screaming at people."

He's Gordon

Nick Pell: Ramsay for bars.

Jordan Harbinger: 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.

Nick Pell: I'll make sure to have popcorn and barf bags ready for the both of you.

Jordan Harbinger: Thank you. I appreciate that.

Nick Pell: Anyway, yeah, traveling too soon can double or even quadruple your chances of getting thrombosis.

Jordan Harbinger: 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.

Nick Pell: Yeah, 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 a tummy tuck or whatever.

Jordan Harbinger: How [00:37:00] common are problems when it comes to medical tourism?

because I, 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.

Nick Pell: We don't really know because there's a survivorship bias involved here.

Jordan Harbinger: 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.

It was 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 fi-..." 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.

Nick Pell: Yeah, my old man used to drive drunk, like, constantly, and lo and behold, he's still walking around alive. It's, does not make drunk driving a good idea.

Jordan Harbinger: Right.

Nick Pell: There's no rigorous official tracking of this. We do have a little data. A large-scale population study found that roughly 5% of [00:38:00] medical tourists report significant complications upon returning to the US.

Of those who experience problems, 67% required medical care back in the United States.

Jordan Harbinger: Wow.

Nick Pell: Data from the British Association of Aesthetic Plastic Surgeons, or BAPS, yes, that's really- ... what they're called.

Jordan Harbinger: BAPS.

Nick Pell: They, uh, they showed a 94% increase in patients needing hospital treatment after overseas surgery over a three-year period.

Jordan Harbinger: Okay, 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, okay, here's some ointment and a bandage." Like, that could be required medical care back in the United States after a surgery.

Nick Pell: Yes, 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 [00:39:00] 6.2% complication rate, which is actually comparable to benchmarks for US board-certified clinics and physicians.

Jordan Harbinger: I see.

Nick Pell: The issue is what are the complications, and that's where we need to get more specific.

There's not a ton of data.

Jordan Harbinger: Yeah, like one is, "Hey, this is a little swollen," and the other one is, "You're going to potentially die from this if you don't go to the ER right now," or whatever.

Nick Pell: Yeah. Like, y- you're a little red here. You need some, you need a cortisone shot versus like, "Whoa, that's necrotic tissue."

Jordan Harbinger: We have to amputate this.

Nick Pell: Yeah, we have to cut that off. So in the United States, you might get a staph infection. In medical tourism, we see nontuberculosis mycobacteria, also known as NTM. I love that whenever I have to pronounce something difficult, I put on my radio news reporter voice.

Jordan Harbinger: Yeah. Otherwise, nobody will understand what the hell you said, so we do

Nick Pell: appreciate

Jordan Harbinger: that.

Nick Pell: That's true. Yeah. These are waterborne bacteria found in tap water used to clean [00:40:00] instruments at lower-end clinics.

Jordan Harbinger: 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. We'll be right back.

This episode is sponsored in part by SimpliSafe. In the US, there's a break-in every 26 seconds, and the problem with a lot of home security is it alerts you after the break-in has already started, and that's too late, obviously. That's why I chose SimpliSafe for our home with the Outdoor Camera Series 2 and advanced AI alerts.

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That's half off at simplisafe.com/jordan. There's no safe like SimpliSafe. This episode is also sponsored by Whatnot. Have you seen the buzz around live shopping? I did not get it at all until I checked out Whatnot. Now I understand why so many sellers are paying attention. I've watched these shows firsthand.

I've seen the rankings. I've looked at the seller numbers. Small businesses, side hustlers, larger sellers are using Whatnot to connect with buyers in a really different way. If you sell online or out of a storefront, you know the challenge, right? You list something, you wait around hoping people find it.

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Download the Whatnot app today and get free shipping on your first order. Just search W-H-A-T-N-O-T, Whatnot, in the App Store and start scoring amazing deals. We'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.

Nick Pell: Wipe it on a napkin and it's good to go. So these are, in addition to being gross-

Jordan Harbinger: Yes

Nick Pell: incredibly hard to treat. They require months of heavy duty antibiotics, and those can cause permanent kidney or hearing damage.

Jordan Harbinger: Oh my gosh.

Nick Pell: So it's not just like eat a bowl full of pills for a month and you're fine.

Jordan Harbinger: No, it sounds like IV stuff- Yeah ... at that point. IV antibi- oh my God, dude, I didn't reali- I f- I, you know, I have [00:43:00] heard of hearing damage and of course kidney damage from antibiotics, but I, ugh, 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,

Nick Pell: yeah.

Jordan Harbinger: The stereotype of Latin law enforcement being essentially freelance has been confirmed by absolutely everybody I know who lives there and has lived there.

And 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 US 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 [00:44:00] lived there was just that it was lunchtime, they 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 n- narco folks in, uh, at the US Embassy.

If you- as you go up the food chain, the corruption is worse and more expensive. You know, it b- it's not a $10 bribe, it's a trip to Vegas or whatever.

Nick Pell: Yeah.

Jordan Harbinger: So yeah.

Nick Pell: Yeah. I've known multiple people who lived in some of the least corrupt countries in South America, and they confirm that, like, you got a problem with your passport or your visa?

Well, if you got 100 bucks, you don't have a problem anymore.

Jordan Harbinger: Yeah, 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 b- 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, and we're going- doing heart surgery [00:45:00] on a vulnerable person, so, like, yeah, we're going to waste $1,000 worth of shit because they might die if we don't. And it's like, all right, that's probably a g- the best practice.

Nick Pell: Yeah, I know exactly one person who's ever bribed American cops.

Jordan Harbinger: That's a story for another podcast, I assume.

Nick Pell: Yeah. So there's also the issue where people stack surgeries. We t- 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 you get your tummy tuck, your breast implant, your lipo, your BBL Your veneers, your Botox, the whole deal

Jordan Harbinger: Yeah, 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."

Nick Pell: 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.

Jordan Harbinger: Okay.

Nick Pell: But abroad, it's like, oh, it's the mommy makeover package. You get six different procedures done.

Jordan Harbinger: Right. And to people like me who don't think deeply about this until right this moment, [00:46:00] it totally makes 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? 'because I'm already going to be on pain meds watching Netflix and sleeping all day. Like, get 'er 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, uh, if this is going to get really gross, maybe heads up, y'all, it might get really gross.

Nick Pell: It's going to get reasonably gross.

Jordan Harbinger: Okay.

Nick Pell: Infections and wound

Jordan Harbinger: dehiscence. What is that?

Nick Pell: Yeah, so infections, people get.

Yeah. Wound dehiscence is when your wounds don't close. They leak.

Jordan Harbinger: Ugh, bro. I've never even heard that word, dehiscence, but man, is that disgusting. So, like, just a festering open sore be- that just-

Nick Pell: [00:47:00] Yes.

Jordan Harbinger: Come on, man. Oof.

Nick Pell: 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.

Jordan Harbinger: 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 y- like you said, a cortisone shot.

I mean, that's really gross. That's really, really gnarl- like, you don't want a wound that leaks. Like, I mean, that's blegh.

Nick Pell: 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, the whole episode, and you get major plastic surgery and nothing goes wrong, we have no idea.

But yes, the [00:48:00] takeaway from this is that if you do have complications, they are going to be a big deal, if not life-threatening.

Jordan Harbinger: Yeah. I m- look, TMI, but hey, what else is new? Um, I might as well keep talking about my wang. I had a r- a, a vasectomy, uh, last year or maybe, no, it was even more than last year. It 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, you know, dying from [00:49:00] it because I had real medical care. No, 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 was just straight-up bad luck."

Nick Pell: Buy a lottery ticket, man.

Jordan Harbinger: Exactly. Exactly. So but how many people actually die from complications from surgery? Do we know?

Nick Pell: The CDC reported 93 US citizens dying following cosmetic surgery in the Dominican Republic. Again, this is specific to the Dominican Republic and US citizens.

Jordan Harbinger: And specific to cosmetic surgery, too, so that's a lot sounding from just that narrow place with a narrow niche.

Nick Pell: And it was just in 2009.

Jordan Harbinger: Yeah.

Nick Pell: Uh, 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 [00:50:00] 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.

Jordan Harbinger: 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.

Nick Pell: Probably, yeah.

Jordan Harbinger: So that's really terrible. I wish we had better stats to compare to the US, because I'd love to get an apples to apples here.

Nick Pell: It's very, very difficult to get apples to apples because you have to compare the exact same surgery, because, like-

Jordan Harbinger: Right ...

Nick Pell: 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." But, like, for the most part, people are not dying from hair transplants.

They're... But lots of people are dying from BBLs.

Jordan Harbinger: 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.

Nick Pell: Yes. Mexico is the number one [00:51:00] 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, i- is probably pretty bad.

Jordan Harbinger: I'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."

Nick Pell: Yeah, or, "I have, like, symptoms that are functionally identical to MS or something."

Jordan Harbinger: Yes, exactly.

Nick Pell: Health authorities in Mexico report that the mortality rate in their medical tourism sector is roughly Four to five deaths [00:52:00] 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 US puts it at one to two deaths per 100,000 for elective cosmetic surgeries. So it's, like, five times as much. Tijuana, big hotspot for medical tourism, that's 20% of all surgical fatalities in Mexico.

Jordan Harbinger: Oh, wow.

Nick Pell: And that's primarily cosmetic procedures like tummy tucks. They have a fatality rate of five in 100,000, 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.

Jordan Harbinger: Ugh, dang.

Nick Pell: 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."

Jordan Harbinger: No, thank you. [00:53:00] No.

Nick Pell: Other 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.

This is a very real concern. One of my best friends was kidnapped in Mexico.

Jordan Harbinger: Well, I mean, I was kidnapped in Mexico 26 years ago.

Nick Pell: And you're who I'm talking about. And also, like-

Jordan Harbinger: Okay.

Nick Pell: My cousin was murdered in Mexico, but he was-

Jordan Harbinger: Oh, dang. I did not know that.

Nick Pell: He was doing sketchy shit, so.

Jordan Harbinger: Okay. Well, okay.

That's like saying my, my friend was killed in LA. Uh, yeah, he was a Crip. Well, okay, not that that makes it okay, but it does increase the likelihood that you're g- you know, if you're buying a brick of cocaine, it can, uh, you're, you're, it's not the same as somebody who's going to the Four Seasons to drink beers at a bar.

What about other places?

Nick Pell: Well, we mentioned Turkey as a hotspot. The British Foreign Office issued a warning after 28 British nationals died in Turkey [00:54:00] following medical procedures since 2019. In 2023, dozens of medical tourists contracted botulism poisoning-

Jordan Harbinger: No ...

Nick Pell: which is a potentially fatal nerve toxin.

Jordan Harbinger: Yeah. How do you get that?

Nick Pell: Stomach Botox.

Jordan Harbinger: Oh, duh, of course.

Nick Pell: 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.

Jordan Harbinger: I see. Okay.

Nick Pell: There's a couple 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.

Jordan Harbinger: Sure. Yeah, if you have, [00:55:00] like, bloo- a blood infection, but yeah, you got it because you got staph from them washing the scalpel in the break room during your whatever, BBL.

Right. Exactly. Yeesh. Okay.

Nick Pell: 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.

Jordan Harbinger: Oh, 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, uh, 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 soundbite that we use on the recommendation of the week.

Lip Filla Clip: I am addicted to lip filler.

Jordan Harbinger: That guy, so he worked in the UK, and he gave this mother of [00:56:00] 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.

And 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, because that makes me sound like I s- 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." So 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, "Ugh, this guy. Come on, man. You're just going to take my money and run?

It's just a really simple edit." And then never heard from him. And then somebody posted on our subreddit, and they're like, "Oh, that guy died." And I was like, "Oh, okay. I guess I won't expect a response to this. Poor guy." Just to have two people die from BBLs [00:57:00] 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.

Nick Pell: Yeah. I mean, surgery in general under the best of circumstances can be very, very dangerous, but-

Jordan Harbinger: Yeah ...

Nick Pell: it's especially true of BBLs. Though new techniques have made them much safer.

The death rate is now 1 in 15,000 for newer procedures, which, like, people are like, "Whoa," after hearing 1 in 100,000.

Jordan Harbinger: Right. It's still super dangerous. Holy smokes.

Nick Pell: But it used to be 1 in 3,000.

Jordan Harbinger: Oh my God.

Nick Pell: Their real-time ultrasound guidance has nearly eliminated the risk of death by fat embolism.

Jordan Harbinger: 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 pics of their bougie recovery suite, and it's like, you know, "Sign up through my link."

Nick Pell: Right. [00:58:00] 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.

Jordan Harbinger: If your surgeon sells vape cartridges out of the front office, we need to talk. But first, let's talk about the fine products and services that support this show. We'll be right back.

Thank you so much for listening to and supporting the show. It 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/deals. Now for the rest [00:59:00] 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.

because like, 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, uh, TikTok conspiracy.

Nick Pell: 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."

Jordan Harbinger: Mm-hmm.

Nick Pell: This is a very real thing. What's the common denominator of all medical tourism?

You want to save money or time. You want a cheaper [01:00:00] procedure or a shorter wait, 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.

Jordan Harbinger: Yeah. Let's talk about kidneys. I mean, you already sort of stole my thunder with the, uh, 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?

Nick Pell: It's honestly, uh, 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.

Jordan Harbinger: Wow.

Nick Pell: There are Chinese websites in English, Russian, and Japanese, not Mandarin, mind you, that promise people new kidneys in one to four weeks.

Jordan Harbinger: 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.

Nick Pell: Yes. And there are definitely regulations that make it harder to get organ transplants in the United States.

Jordan Harbinger: Yes.

Nick Pell: But the [01:01:00] 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.

This 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.

Jordan Harbinger: 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 pe- 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.

Nick Pell: So here's the thing. Biologically, you cannot schedule a deceased donor transplant weeks in advance unless you know exactly when the donor's going to die.

Jordan Harbinger: Okay.

Nick Pell: And this is what first tipped off international investigators That something was amiss in the People's Republic of China.

Jordan Harbinger: Yeah. Yeah. I can [01:02:00] 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?

Nick Pell: 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.

Jordan Harbinger: Yes, and I can stop playing dumb now, but you can hear more about this on episode 497 with David Kilgour who did... He was a part of that whole UN China Tribunal. It's crazy.

Nick Pell: 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 [01:03:00] 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.

Jordan Harbinger: Yeah. By the way, uh, Falun Gong is like a meditation.

If I say cult, people flip out, but it's sort of kind of like that. But I, 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, uh, the Communist Party of China, and so they're getting persecuted and, 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 a high-quality liver from the person that gets arrested and h- murdered for, for, for their corneas or whatever it is.

And yeah, I mean, if people are coming back from camps and the numbers don't match and they're [01:04:00] getting organ health tests rather than general wellness tests, I mean, that just kind of seems like a pretty big tell, and I, I'm not alone in thinking that because there's a whole UN tribunal, the whole China tribunal kind of came to the same conclusion here.

Nick Pell: 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. Sometimes it's a real crime, other times it's not a crime at all.

Jordan Harbinger: Well, yeah, a cri- 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.

Nick Pell: Yes. And it seems like they just, you know, 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 [01:05:00] coming from.

Jordan Harbinger: 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. You, look, 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.

Nick Pell: Yeah, and I think that we can be like fair in acknowledging the pressure that these people are under- Yes ... but that does not absolve them of the ethical implications of what they're doing. You know, both things can be true.

Jordan Harbinger: Yes.

Nick Pell: So several countries and some US 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. The American Stop Forced Organ Harvesting Act moved to sanction individuals and even entire medical systems involved in this trade.

Jordan Harbinger: Man, sounds like something out of a horror movie, dude.

Nick Pell: Yeah, it sounds like an Eli Roth [01:06:00] 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, 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.

Jordan Harbinger: Why is there no international enforcement against organ harvesting, or is there?

Nick Pell: Well, international law is a gentleman's agreement. Where's the carrot and the stick for international law?

Jordan Harbinger: That's true. What about the sanctions you mentioned? I mean, we're not going to sanction China 'becausethey're selling a few thousand organs per year probably.

Nick Pell: No, because it's a rich mine of slave labor for cheap consumer electronics in the West, and th- and China can absolutely skirt basic human decency on a lot of fronts because the w- rest of the world's decided that they would rather deal with them for $800 [01:07:00] iPhones than do anything about it.

Jordan Harbinger: Yeah, that's not going to change.

Nick Pell: 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.

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.

Jordan Harbinger: Yeah, I... It's... Man, this is so tough, because I'm trying to think, like, would I do it? What if it was my kid, would I do it? And I'm like, "Oh, man, this is, like, r- it's really tough.

It's really tough to make that decision." So okay, say you've decided you want to go abroad for a procedure. Where would you begin risk management?

Nick Pell: 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 [01:08:00] 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.

Jordan Harbinger: So the place to start, what, is the CDC website, I suppose, that has medical tourism alerts on it. I 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.

Nick Pell: Yeah. The, um, 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.

There not being any available evidence for malpractice does not automatically make a surgeon safe. It's just the bare minimum.

Jordan Harbinger: I see. What are some red flags for people to look out for?

Nick Pell: [01:09:00] In the US, board-certified plastic surgeons generally don't offer BOGO discounts or, you know, any kind of deep discount.

Surgery's a medical procedure, it's not a Black Friday doorbuster. 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.

Right. They got more than they can- One

Jordan Harbinger: of

Nick Pell: those dudes- Yeah, they got more than they can deal with ... tossing the sign around outside and dancing- ... with the headphones in. One of those guys on

Jordan Harbinger: the corner.

Nick Pell: Yeah, they don't need that. We talked a lot about infections and complications, some good question... 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.

Jordan Harbinger: Yeah, you would think so. So if a broker says you can fly home five days after a major [01:10:00] procedure like a tummy tuck or a BBL, it sounds like they're prioritizing their bed turnover over your life and recovery. And 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.

Nick Pell: 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.

Jordan Harbinger: 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 healthcare by simply getting on a plane.

Nick Pell: Yeah, and you might be hacking your wiener off if you do. That's right. So I would be very, very careful.

Jordan Harbinger: Speaking of life hacks, how about chopping off that extremity?

Yeah.

Nick Pell: Yeah. The global medical market is not a loophole, it is a trade-off, and you may [01:11:00] 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-

Jordan Harbinger: Right.

Nick Pell: Yeah ... 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. And you are trading a- 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.

Jordan Harbinger: No, uh, I don't want to have one anywhere, but if I have one somewhere, I hope it's in, uh, n- next to the, what, was it the Cleveland Clinic or the Mayo Clinic?

Nick Pell: Dude, I don't want to have one at the hospital down the street from me.

Jordan Harbinger: Right, right.

Like- Right ...

Nick Pell: you know?

Jordan Harbinger: Yeah. I want only the best guys on the job. All right, as we [01:12:00] explored with the grim reality of transplant tourism, there's an extremely ugly side to medical tourism in general. Whether 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@jordanharbinger.com. Advertisers, deals, discounts, ways to support the show, all at jordanharbinger.com/deals.

I'm @JordanHarbinger on Twitter and Instagram. You can also connect with me on LinkedIn. This show is created in association with PodcastOne. My team is Jen Harbinger, Jase Sanderson, Tadas Sidlauskas, Robert Fogarty, 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 [01:13:00] 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. In 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.

Mariana van Zeller: I've been covering the cartel for many years now, and I sort of wanted to do a story about cartel presence in the US, 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 US, including the fact that they're in small town America.

So one of our first shoots for that episode was in Georgia, and we started with the murder investigation of this woman who was [01:14:00] 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 yeah, realized that they're everywhere, and particularly like to operate in small town America.

Less law enforcement, easier to hide the drugs, and to have their distribution networks. You know what was so interesting about that story is that in order to get access to the cartel in the US, we actually had to go down to Mexico and gain permission and have them say yes. Because a lot of these groups have people that work for them in the US, obviously, the US is the end goal where they're sending their drugs.

And so eventually he said, "Okay, 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, and the guy never showed up. I want people to see many of these traffickers, again, do- 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.

I [01:15:00] try to always do my job as a journalist, which is hold people accountable.

Jordan Harbinger: If you want to hear how cartels hide in plain sight, check out episode 1302 of The Jordan Harbinger Show.