Live Long and Master Aging podcast

Episode

253

Is it worth having a full body MRI scan?

Andrew Lacy, Prenuvo | Dr. Mirza Rahman, American College of Preventive Medicine

BY PETER BOWES | WEDNESDAY JUNE 12, 2024

I recently had a full body MRI (magnetic resonance imaging) scan. An early screening method, which has grown in popularity in recent years, the procedure is widely criticized by professional medical bodies and generally not covered by health insurance. My goal was to experience the scan – which is considered safe – and the follow-up process from the perspective of a patient. Unlike X-ray and CT scans, MRI does not involve exposure to radiation. 

This episode explores the issues surrounding full body scans, with two interviews.

  1. Andrew Lacy, Prenuvo
  2. Dr. Mirza I. Rahman, American College of Preventive Medicine

At a cost of up to $2,500, full body MRI scans are touted as a useful tool to catch potentially serious medical conditions – early markers of diseases such as cancer and aneurysms – at a stage when they can be treated. Critics argue that there isn’t sufficient evidence to justify screening asymptomatic patients, given that they can result in unnecessary anxiety and follow-up procedures. They cite the discovery of incidental findings – small abnormalities that are harmless and usually require no treatment. 

I was offered a complimentary scan by the US company Prenuvo which uses custom made MRI machines to scan the entire body. It takes one hour. The company provides a detailed report and follows up with a consultation with a nurse practitioner. I went over my scan with one of Prenuvo’s radiologists, who advised me that nothing could be seen that suggested any significant medical issues. There were, as expected, several incidental findings – or  incidentalomas – which is what troubles the wider medical community. They may – or may not – be indicative of a problem and pose a dilemma for the patient over what to do next. I was also advised that a full body MRI is not a substitute for traditional ‘gold standard’ screening techniques, such as colonoscopy and endoscopy to examine tissue of the gastrointestinal tract, mammograms to check for breast cancer or ultrasound and a physical examination for the testicles.

ANDREW LACY

Andrew Lacy, Prenuvo founder and CEO, discusses the balance between personal and population-level health benefits and pitfalls, and the future potential of full body MRI scans.  He says the goal is to detect abnormalities early and significantly benefit patients, particularly those with past cancers or indeterminate health issues. He explains that the main draw for many is peace of mind, believing that early intervention could prevent severe health issues.  He advocates for more preventive and precision medical practices while acknowledging that more research is needed fully to understand the propriety of such scans for the general population. 

Prenuvo – additional information

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CHAPTERS (time stamps go to YouTube) | Read a full transcript of this interview

  • 00:01 Introduction to Full-Body Scans – Peter Bowes discusses undergoing a full-body MRI scan for preventive health purposes, including concerns about potential health issues and the anxiety they might cause. Images show the result of Peter’s scan. 
  • 02:09 Andrew Lacy’s Background – Andrew Lacy shares his motivation stemming from personal health concerns and his journey from being a non-medical professional to starting Prenuvo.
  • 05:58 Business Scale and Expansion of Prenuvo – Lacy outlines the growth plans for Prenuvo, with ten locations across North America and goals to establish more clinics to make preventive health more accessible.
  • 06:28 Explanation of MRI Technology  – A technical overview of how MRI scans work, their safety, and what they are best suited for, notably resolving soft tissue rather than bone or calcium.
  • 11:37 Findings from MRI Scans – Detailed outcomes from scans including life-threatening conditions, serious but manageable issues, and incidental findings, encouraging lifestyle adjustments.
  • 14:28 Motivations for Electing Full-Body Scans – Main motivations include managing anxiety from personal or family health history or to diagnose unexplained symptoms where other medical avenues have failed.
  • 16:44 Addressing Anxiety and False Positives – Discussing how preventive scans can cause anxiety and stress, and managing false positives by ensuring clarity in follow-up procedures and communication.
  • 21:20 Professional Criticism and Evidence  – Addressing criticism from the American College of Radiology about insufficient evidence for whole-body scans and the need for long-term studies to validate their effectiveness.
  • 30:40 Personal Experience and Costs – Peter shares his personal experience with the scan, the results, images and follow-up consultation.
  • 38:12 Future Prospects and AI – Efforts to reduce costs through the use of AI, scaling operations, and investment in faster imaging technologies to make these preventive scans more accessible and widely adopted.
  • 42:37 Positive Outcomes and Real-Life Impact – Real-life examples of how early detection through MRI scans has led to life-saving interventions, with particular attention to under-screened cancers.

THE CASE AGAINST FULL BODY SCANS

DR. MIRZA RAHMAN

To explore the opposition to such scans, I also spoke to the president of the American College of Preventive Medicine (ACPM), Dr. Mirza I. Rahman. He strongly opposes the use of full body MRIs as a screening method for patients with no symptoms and challenged companies like Prenuvo to provide peer-reviewed evidence that patients stand to benefit from such interventions.

Additional information

CHAPTERS (time stamps go to YouTube) | Read a full transcript of this interview

  • 00:01 Introduction and Purpose of Discussion Dr. Mirza Rahman explains the common goal of improving quality and length of life, but highlights the controversial use of full-body MRIs.
  • 02:23 Medical Opposition to Full-Body MRI Scans Discussion on the opposition from medical bodies like the American College of Radiology, emphasizing lack of evidence supporting full-body scans for asymptomatic individuals.
  • 03:03 Role and Goals of the American College of Preventive Medicine Dr. Rahman explains the objectives and activities of his organization and calls for more emphasis on preventive medicine.
  • 4:37 Challenges in Preventive Medicine Funding Discussion on the inadequate funding for preventive medicine residencies and the urgent need to lobby for changes to support preventative healthcare practices.
  • 06:09 Dr. Rahman’s Career Background Short background on Dr. Mirza Rahman’s experience in public health, academia, and the pharmaceutical industry.
  • 07:30 Full-Body MRI Scans: Risks vs. Benefits An in-depth discussion of the risks versus the touted benefits of full-body MRI scans, questioning their utility and effectiveness.
  • 10:52 Risk Assessment in Medical Screening Dr. Rahman provides a primer on epidemiology focusing on sensitivity, specificity, false positives, false negatives, and positive predictive value.
  • 15:44 Controversies Surrounding Full-Body MRI Scans Examination of the higher prevalence of false positives in people without symptoms and the subsequent financial, medical, and emotional impacts.
  • 26:16 Individual vs. Population-Level Screening Exploration of the difference between individual and population-level considerations in the use of full-body MRI scans.
  • 31:14 Societal Impacts of Full-Body MRI Scans Discussion on the economic and social implications of full-body scans, particularly for different societal levels.
  • 33:56 Future of Full-Body MRI Scans in HealthCare The need for further research and evidence to justify the widening use of full-body MRI scans, along with an encouragement to focus on proven health practices.

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TRANSCRIPTS

Andrew Lacy: This interview was recorded on April 23, 2024 and transcribed using Sonix AI. Please check against audio recording for absolute accuracy.

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Peter Bowes: I recently had a full body scan. In this room. You can hear the sound of the MRI machine behind me, a large tube that contains powerful magnets to peep inside my body, head to toe, to screen for possible medical problems, try to head off or get an early warning about potentially life threatening conditions. The result is a series of very detailed images covering every organ, every nook and cranny of my 62 year old body. But is it worthwhile? Is it worth the money to have such a procedure, even if you’re not experiencing any symptoms? And what about the angst and worry it could cause you if they find something?

Andrew Lacy: We now have patients that come in routinely every year or two, and it’s not a scary thing. It’s additional knowledge to help them live their lives better. The likelihood of anything really crazy coming up is quite low and intentionally so. If you do it routinely, they know that if anything’s caught, it’s going to be caught very early because it wasn’t. There was nothing on the scan the year before. The challenge is getting over that initial, I would say hesitation. Once you do that, the hope is that you can sort of outsource a lot of your anxiety or concerns about health to companies like Prenuvo and other people that are operating in the preventive health space.

Peter Bowes: Andrew Lacy is the founder and CEO of Prenuvo, a company that offers a one-hour screening using MRI – magnetic resonance imaging – with the goal of catching abnormalities while they’re at a stage that can be successfully treated. It’s a practice that has many critics, with some health professionals saying there isn’t enough evidence to justify screening for patients with no clinical symptoms or a family history suggesting they could be at risk. We’ll look at those arguments.

Peter Bowes: Hello again. Welcome to the Live Long and Master Aging podcast, I’m Peter Bowes. This is where we explore the science and stories behind human longevity. Andrew, thanks for joining us.

Andrew Lacy: Hi Peter, it’s great to be here. Looking forward to diving in.

Peter Bowes: Good to talk to you. And we first met a few weeks ago now at the Live Long Summit in Florida. We took part in a panel on this subject you invited me to at your facility here in Los Angeles to have a scan. And just for full disclosure, that was done at your expense. That was a complimentary scan for me. I’ve since had my results. We’ll discuss my results in a few moments time, but I think it’s probably best. First of all, just to talk a little bit about you and how you came into this business, I guess the first, perhaps important thing to say is that you are not a doctor. You are a businessman. So I’m just curious what your background is and what brought you to this.

Andrew Lacy: Yeah, no, I’m happy to share that. In fact, it’s so interesting as I start to travel to some of these longevity summits, I sometimes feel a little bit like I’m the, I’m sort of the odd duck. I, you know, I’m not a Iron Man running triathlete, performing six pack wearing, longevity, advocate. I’m a pretty average person. And how I got into this was, you know, I entered my 40s and like many of your listeners can probably relate to, I lived a life where I was working too hard. I was not exercising enough, I wasn’t eating well enough, and I was doing all this in the service of a future that I sort of automatically expected I was going to be part of. And I remember waking up one day and looking in the mirror and asking myself the question, wow, you know, like, is all this effort and work going to be worth it? Will I be around? How do I know? Just the impact that the way I was living my life was having on my underlying physiology. And so I went in search of answers. And that journey led me to a very small clinic in Vancouver, Canada, that were doing these very detailed whole body scans. I went and did that scan, the same scan that you did, last week and sat down afterwards and went through every single organ in my body. And I felt like I was meeting myself for the first time. I learned that there was nothing crazy serious that was happening under the skin. But I learned a lot of practical information about how I can make small adjustments to my lifestyle that hopefully will change the trajectory of my life. And as soon as I went through this process myself, I, I sort of fell so in love with it that I just wanted to work harder, even still, to bring this to as many people as possible and that, you know, the fruits of that labor is Prenuvo and the clinics that we’re building across North America.

Peter Bowes: And what is your professional background? As I say, you’re not medically trained, but you’ve been in business for a long time. In other words, what brought you to the point that you were able to launch your own business doing this?

Andrew Lacy: Well, you know, part of being an entrepreneur is just believing that you can, you know, build something new, that you can bring a perspective that’s different and unique. And I’ve been fortunate enough to have built several different types of companies, never in the same industry. I was really personally looking for a endeavor where the KPI of success was not necessarily just how big the company was, but in the case of Nuvo, how many lives that were potentially saving and of course, this is a medical business, so and I’m not a medical person. So I’ve have a wonderful team of medical experts that help us bring these scans to as many people as possible. But, you know, for the most part, my job is to make sure that the company is well funded enough so we can continue to grow and and expand as fast as we’re able to as a business.

Peter Bowes: The company’s called Prenuvo. What does Prenuvo mean?

Andrew Lacy: It was originally a name that was based around a person whose name was Renu, actually a friend of the founding radiologist who had passed away from late diagnosed cancer. So it was sort of a alliteration of prevent another Renu. So, it was meaningful for us as a company. And spoke to what it was that we were hoping to achieve as a business. 

Peter Bowes: Just give me idea of the scale of the business. Now, I mentioned that I went to your facility here in Los Angeles. 

Andrew Lacy: Sure. We have ten locations right now, across North America. We are looking to build another 10 or 15 over the next 18 months. Most of those clinics are in large metropolitan areas like San Francisco, L.A., New York, D.C., Chicago, Miami, and so on. But obviously, there are a lot of people for whom these scans can be very beneficial that don’t live in those cities. And that’s why we’re working to scale as fast as we can.

Peter Bowes: So let’s get into the detail. What is an MRI?

Andrew Lacy: Wow. Straight out with the the physics question. So obviously an MRI is a very big magnet. When we place you inside that magnet, we are, we send these EF (sic*) pulses into your body, and that orients the hydrogen atoms in our bodies. [*Ed note:  the term, as intended, is RF pulses – ‘radio frequency’] And most all of the components of our body have hydrogen some where in them. And then as we switch off that pulse that relaxes back in the direction of the magnet, and we are able to pick up a very, very tiny signal of that happening, from these coils that we put on people’s bodies, and we’re able to turn that radio frequency data into images of the body. And these images are sensitive for anything containing hydrogen, so fat, blood, fluid, proteinaceous tissue. And so we’re able to take these very, very detailed images of the entire body and filter for all of the different types of tissue we expect to see in there. And this enables us to look in each organ in tremendous detail and be able to diagnose most anything that we can see physiologically in the body.

Peter Bowes: And of course, MRIs have been around for a long time. There’s nothing particularly new in that technology. Just give me an assessment of the safety factors here. I think that is a big concern of a lot of people when they go into something like this. And maybe just the physical experience is is quite daunting for some people disappearing into that long tube. But how safe are they?

Andrew Lacy: Well, they’re very safe. In fact, you could do one every day if you had an occasion to do it. There’s no radiation, unlike an x ray or a CT machine. We don’t use ionizing radiation to collect these images. And then secondly, unlike many other medical imaging exams, we don’t use a contrast agent either. So in the case of MRI, that would be a heavy metal contrast that we would inject into your body. In order to visualize the blood vessels a little bit easier. There are great diagnostic reasons to do contrast imaging, but when it comes to screening an exam that we hope people will do once every year or two, we don’t want that heavy metal to accumulate in the body. And our principle generally is we want a screening exam that’s 100% safe that you could do as frequently as you have a medical reason to do it.

Peter Bowes: And I mentioned this is quite literally a head to toe scan. You’re screening the entire body, but to greater or lesser extents, what can it screen for? Because MRIs are better at some things than other things, aren’t they?

Andrew Lacy: Yeah. The MRIs are generally really good at resolving soft tissue. And what they’re not so great at is resolving bone or calcium. In fact, calcium is completely invisible on an MRI machine. So if someone has a large kidney stone, we see it through the absence of signal on an MRI. It’s almost like a black hole. And so this is why if you break your arm, you get an x ray, because x ray is very good at seeing that bone. A CT is a spinning x ray. So that also works very well for bone and is used for other organs as well. But there’s nothing better than MRI when it comes to resolving the soft tissue. And of course in the soft tissue is where all of the problems that we can have, um, you know, are manifest. So cancers tend to begin in the organs and only at a later stage do they move to bone. Obviously there are many other sort of chronic conditions, kidney disease, liver disease, etc., etc. that are in the organs. And so MRI has always been the modality of choice.  For a screening the challenge has been that’s just been very, very slow. And what Prenuvo does is speed that up. You know, an order of magnitude.

Peter Bowes: So for some people who might be concerned about calcification, their arteries, their cardiovascular health, this isn’t necessarily the screening plan for them.

Andrew Lacy: Correct. No. We we often recommend folks, particularly when you’re, you get into your late 40s, if you haven’t already, perhaps to go get a calcium score to make sure that you’re not depositing — you know, you don’t have calcification in the arteries supplying the heart. And so that’s probably the main area where MRI struggles. We can resolve the heart very well. And we take very beautiful pictures and videos of the heart beating. The challenge with MRI is because the heart is beating and because you are breathing. There’s just a lot of movement to have to gait for, and that makes MRI very slow, whereas CT, being a lot faster, does a much better job of the heart.

Peter Bowes: So tell me typically what you do find in people and the range of potential problems that they could reveal, from potentially fatal conditions to things that you might just want to keep an eye on, things that are just intrinsically there as part of our bodies that are maybe will show up on a scan, but are not going to cause us any problems.

Andrew Lacy: Sure, there’s really three categories of findings. The first are potentially life threatening conditions. And here I would say the vast majority are cancers and various types of aneurysms. You can get aneurysms not just in your brain, but also aortic aneurysms, abdominal aneurysms. And these are things that if they burst, they often, more often than not tend to be fatal. We find cancer and aneurysms in about 3 to 4% of people, so about 1 in 20 to 1 in 25, depending on the market and the age of the patient. The vast majority of those cancers are stage one, which means that they’re often times resectable and, you know, treatable with a much higher probability of a successful outcome, including cancers, that there are no screening modalities for, like ovarian or pancreatic cancer. The second category are things that we consider serious enough that we want you to pay attention to, because these are conditions that might evolve into a chronic, debilitating medical issue in the future. So things that fall into this category are medical conditions like fatty liver, severe spinal issues, small vessel ischemia, which tells us that there’s something going on with the plumbing, so you maybe have a cardiovascular issue, and that’s affecting the blood supply to the brain. So there’s any number of these conditions that you should pay attention to because they’re important. And we find those in around 10 to 15% of patients. And then the vast majority of other patients, what we give is peace of mind that there’s nothing going on under the skin. And oftentimes some incidental findings that are useful to know but are not necessarily medically relevant. And these range from benign conditions like cysts or hemangiomas, which is good to know they’re benign. If someone ever finds them later on, you may be avoid additional testing or biopsy or congenital issues like people that don’t realize they’re born with only one functioning kidney or they might notice we’ve found women that have double uteri, for example. There’s obviously we’re all very unique and there’s a lot of unique, anatomy inside all of us that oftentimes is not necessarily medically relevant but is good to know.

Peter Bowes: And what do you find is the main motivation for people to do this kind of scan? Is it a preventative tool in the box that they just want to prevent, as you’ve just described, perhaps conditions that could be very harmful in the future? Or is it because they’re experiencing a symptom, and perhaps they’ve been recommended by a doctor to have this kind of full body scan? What is the main motivation?

Andrew Lacy: Well, I would say the biggest misconception about these scans is that this the sort of market for this are young, worried well, life, lifestyle and longevity optimizers.

Peter Bowes: The healthy wealthy as they’re sometimes…?

Andrew Lacy: The healthy wealthy, and the vast majority people that fit in that category do come in and get screening. So I’m not saying this is not a small segment for us, but I would say the two largest segments are, first of all, patients that might have had cancer and they’re worried about coming back or have a family history of disease. And for these folks, not being screened is causing them anxiety. Not knowing the status of their health is concerning to them. And then the second category are people that have these indeterminate findings. So these are folks that. You know, they might have migraines periodically or they might, `women that have abdominal pain and they’re struggling to get the health system to actually do testing to figure out what’s going on. And they sort of come to us. To sort of House M.D. the thing and figure out exactly what’s going what is actually the issue with their health so that they can get treatment a lot faster. And those two use cases, in some ways, are the two largest use cases that we have. And speak to the notion that really health is important for everyone. There’s a lot of people that, again, don’t have six packs and aren’t, you know, triathletes that for which they want to make sure that they can live a long and healthy life and they make use of these services.

Peter Bowes: What about the and I heard a lot of people discuss this. What about the anxiety factor that goes into going through a scan like this? And clearly there’s a level of anxiety between the scan and getting the results. But the results themselves, and especially those results that are inconclusive, that perhaps need some follow up that may not be serious but could potentially be a problem in the future that is going to, to greater or lesser extent, create anxiety for individuals. And I’ve heard some people say they literally went through hell worrying about what had been found before it could be conclusively diagnosed. How, as a provider, do you deal with that and guide people and advise people how to cope with that mental anguish that a lot of people could feel?

Andrew Lacy: Well, I think this question of anxiety is not really something that’s limited to Prenuvo and the screening that we’re doing. I mean, any screening exam comes with a certain level of anxiety. And we see this. I mean, we’ve seen this in studies for mammogram, for example, or colonoscopy or lung cancer screening. And these are standard of care screenings where we’ve decided that in spite of that anxiety, you know, these tests are worthwhile. They save lives. At the same time. Really, we have to start thinking and evaluating, you know, where does this anxiety come from? Why is it that, you know, I don’t have anxiety about taking my car to go get a, you know, a 500 point checkup on it? But I do have anxiety about going to get a big checkup on my health. So what has created that anxiety. And I’ll put it to you that the source of that anxiety is our reactive health care system, because you only enter the health care system when there’s something very wrong with you. And any medical diagnosis is in and of itself, you know, concerning worrying, life threatening, expensive, poor probability of a great outcome. And so we’ve been trained to think about health issues and disease. As something that’s horrible and scary. And I think if anything, the world that we’re trying to create at Prenuvo is one where it’s affirming. We catch things, Everything early, you know, we focus on keeping the engine running. So all we need are oil changes and, you know, maybe being told not to ride the brakes as heavy as we have been and versus having to like get the transmission changed out, you know, when our car sort of stops working and and I think that’s a much more I mean, that’s a world that I want to live in where, you know, I’m in control and I’m not scared because I know that I’m catching everything early when I can do something about it.

Peter Bowes: One of the phrases that is often used is ‘false positive.’ And we’ve kind of covered this already, but that is finding things that that may be a problem that needs some further diagnostic testing that actually turn out not to be an issue at all. That’s my understanding. You tell me, though, what is your definition of a false positive? And how do you explain that to people and help them to move on from it?

Andrew Lacy: Well, it’s such a weird, it’s a sort of a weird expression in the context of screening. Right? Because we are. There are many conditions where we can ultimately diagnose it. We’re gold standard. So things like fatty liver, you don’t really need to go and get another test. But many things like cancer, we don’t definitively diagnose it. We risk stratify everything that we see. So we see a lesion in someone’s liver and we say, okay, this is because of the characteristics of this lesion. This is this is highly likely to be benign. And you know, the best course of action here is to just check again next year when you get a scan. Or this is, you know, highly likely to be concerning, you absolutely should go and follow up with a specialist to get this further checked out. So so the real question is, you know, how much of that further investigation leads to dead ends as opposed to, you know, diagnoses that help save lives? I’m not even sure which outcome I’m sort of rooting for, because obviously, you hope that if you find something concerning that, you know, it ends up being, you know, a dead end for the patient. But I would say these. Any medical image test has a certain level of false positives. The more you try to push the sensitivity of the test, the more you pick up things that ultimately aren’t medical conditions. And so any test, you’re balancing these two factors. How sensitive do I want to be and how specific do I want to be for the things that I’m able to diagnose? And, you know, these have been studied, they’ve been studied by us internally. They’ve been studied internationally. In fact, there was a big meta analysis that just got published a few months ago where we found that indeterminate findings from whole body exams are around 16%. And this compares favorably to standard of care screening. So we don’t think that there’s a higher rate of false positives here than other imaging tests that are already part of standard of care. And we continue to work to establish evidence to prove that to the medical establishment.

Peter Bowes: Well, I mean, you’ve hit on exactly the point that I was coming to that the medical establishment doesn’t seem to be convinced yet in terms of the evidence. And I just want to read you a statement from the American College of Radiology. This is a statement they released last year outlining their position. It says: “The American College of Radiology, the ACR at this time does not believe there is sufficient evidence to justify recommending total body screening for patients with no clinical symptoms, risk factors or a family history suggesting underlying disease or serious injury. To date,” – the statement goes on – “there is no documented evidence that total body screening is cost efficient or effective in prolonging life. In addition, the ACR is concerned that such procedures will lead to the identification of numerous nonspecific findings that will not ultimately improve patients health, but will result in unnecessary follow up testing and procedures, as well as significant expense. The ACR will continue to monitor scientific studies concerning the utility of screening total body MRI.” So that is a statement from a body representing radiologists who as a profession, you would think would benefit if more people were having scans like this. What’s your response to it?

Andrew Lacy: Well, it’s a big sort of nothing statement, to be perfectly honest. I mean, you know, saying – the question I guess you have to ask is when folks are asking for evidence, what evidence are we looking for generally and with any test where you’re evaluating whether the screening test is something that you want to apply at the population level, you’re typically looking for all causes, reduction in mortality. And when you when you are assessing all cause reduction mortality, you automatically and instantly require something like a 20 or 30 year study.So. Just as there is no yet definitive evidence of all causes reduction in mortality, there is no definitive evidence that these tests are not valuable for people’s health. There’s no evidence that these tests are not cost effective. There’s no evidence that these tests do not, you know, there’s no evidence against these tests saving lives. So we need more study and evaluation. That takes time. I wish it was faster. I wish the health system,you know,worked off sort of first principles a little bit more than require 30 or 40 year studies. But unfortunately, that’s been the history of screening. And it’s part of the reason why we have 3 or 4 different screening exams and not more. Each one of them took a tremendous amount of time. Mammogram 30 years, pap smear 30 years. Lung cancer screening 25 years, PSA 20 years. So all of these tests had exactly the same critics at the outset. And now these are standard of care and acknowledged as saving millions of lives.

Peter Bowes: Isn’t it the nature of science, though, that to do things properly, it takes time?

Andrew Lacy: Sure. Again, the Peter Attia in his book Outlive, he sort of talks about, you know, standards of proof. And he said the first level standard of proof is, you know, is does this do harm, you know, and is there a is there potential upside for this individual given their individual circumstances? And I think he he asked this question in the context of whole body screening and found the answer to be favorable. Beyond that. You know, is there evidence of cost effectiveness at a population scale? Well, that’s a totally different question. And again, requires population level evidence, appropriately weighted, sometimes double blinded, over a period of time. And we’re working to collect that evidence, but unfortunately you just can’t collect it, tremendously fast. And so then the question becomes, well, is this a test that’s appropriate for me as an individual? Do I understand the risks of the test? Do I understand the potential benefits? And am I prepared to, make that choice, in the interest of furthering my own health?

Peter Bowes: That’s an interesting argument. And the phrase population level evidence is something that we hear quite a lot in relation to this debate. And I think for I’m trying to put myself in the position of a layperson, someone with no medical background, no advanced degree in population health, that someone who is concerned about their own health, hearing that something at a population level isn’t justified. And I’m just curious to get your, again, definition of that and what it actually means. And I think to some extent what my understanding is that something that a population level isn’t justified suggests to me that something could be detrimental to all of us, because perhaps it could put an unnecessary burden on the health systems that we are all working within. Perhaps,you know, maybe to the benefit of an individual. But at a population level, as, as many professionals say, it simply isn’t worth the money.

Andrew Lacy: Yeah, I think the difference here is, what health system are we trying to either create or prevent? And the health system that Prenuvo is trying to create is one that’s transformed and built around, preventative precision medicine. And we fundamentally believe that that health system. Yes. Although we may spend more money up front doing screening to test for disease, we will catch things early at a point where just lifestyle intervention oftentimes is the only thing that’s required to be done, or if there is a requirement to access medical treatment, that that treatment is easier to perform and therefore cheaper. And if we do that at population scale, the makeup of our entire health care system would look very different and we believe would be much smaller, which is fantastic because with an aging population, we already have a health system that’s bursting at the seams. If you look at these tests and evaluate them just sort of incrementally, then, you know, then you run the risk of sort of missing the bigger point here, which is that we have a health care system that’s pretty unsustainable as it is, and is only going to get worse. And there needs to be a willingness and openness to evaluate much more fundamental and transformative approaches that might,you know, represent the future, you know, of health care, versus evaluating incremental improvements, new drugs, or, you know, new interventions to help people with advanced disease just live a little bit longer. That seems like the wrong thing to be optimizing for.

Peter Bowes: I’m putting myself in the position of the layperson, wondering why there is such a gulf, such a wide gap in opinion when listening to you. At the surface, very reasonable arguments about personal health care. And the professional bodies. And I’ve quoted from one. But there are others who are very significantly critical of what you’re doing. There seems to be no middle ground in the profession.

Andrew Lacy: No one has to really understand that what they’re making is a scientific statement. And there’s a risk when you make a scientific statement to a consumer audience that you interpret this in the way that it’s not intended. The statement that these bodies are making is there is not yet sufficient evidence, and we stand ready to receive that evidence and evaluate it on its merits. However, when you when some of these bodies or sort of experts speak to a consumer audience, the way that this is often received is that there’s something wrong with these exams, there’s not necessarily anything wrong. There’s just not been evidence that these things are something that we necessarily want to adopt yet at a population level. And, and that’s why when you first asked the question, I said this is a very innocuous statement because I interpret that as a scientific statement. I don’t interpret that sort of I don’t sort of.. I don’t go any further than that. And unfortunately, I think these types of scientific statements should be, measured if they are given in a consumer context.

Peter Bowes: So a big part of the disagreement then, is how long do we wait for the evidence – that there is some evidence that you are basing your activities on, but you would like to see more, others would like to see more. And that in your view, there’s enough evidence, at least now, to justify what you’re doing, but you’re acknowledging that there could be more evidence.

Andrew Lacy: Absolutely. And and I would love to go back and talk to all of the folks in the 60s, when mammogram was first clinically proven and who spoke out against mammogram and speak to them 30 years later and ask them the question, well, how do you feel about those statements? Because they haven’t aged very well. And what about people that relied on them in the intervening period who didn’t perhaps get a life saving screening exam that they might otherwise have got? I think we just have to be very careful where there is a lack of evidence that we, you know, empower patients with the knowledge so that they can make an informed decision about what’s right for their own health.

Peter Bowes: So let’s talk about my experience. I started by saying that I had a scan at your facility in Los Angeles, and I’ll just talk you through. It was, more than an hour that I was at the facility. The scan itself lasts for an hour. You arrive, you check in. It’s a pretty quick process. You go into a changing room, you undress down to your underwear. You wear a gown, two piece gown, and you’re taken into the screening area. Having taken off your watch and all the metal that’s attached to your body. And you’re given some instructions by the the technician, and you’re offered the opportunity to listen to some music or even watch a video. I actually chose the. I actually initially chose nothing because I kind of wanted to experience what it was like without any distractions, but did eventually get some music. And I think probably the first thing to say about the experience of being in this long tube and people’s concerns about it being claustrophobic is that, well, at least I didn’t. And I’m just one person. You can’t really judge at a wider level just based on my experience, but I didn’t find it claustrophobic. And in fact, your head is heading out of the back of the the tube for a significant amount of time and you’re actually looking into the room. I know you offer don’t use sedatives to to some people who are particularly worried about that. I refused that. And apparently most people don’t feel as if they need a sedative to go into this tube for an hour. So you lie there. You’re asked to breathe in, to breathe out. A number of times your body is moved on a kind of a trolley device. You’re moved in and out. It’s very similar to having a scan atany other medical facility, an MRI or a CT scan. And you emerge after about an hour and you get dressed and and off you go. And I had mine, I think, on a Thursday. By the following Monday, I had my test results. It’s not always that quick. I guess it depends, Andrew, on how busy your people are in terms of how quickly the results come through. Then I had a consultation online with one of your doctors, and we spent over an hour talking in quite a lot of detail about what the scan found about my body. You’ve referred to it. The images themselves are really quite graphic, aren’t they? There are. 

Andrew Lacy: There’s nothing that you can’t see.

Peter Bowes: There’s nothing you can’t see. The first thing that I was told within the first 10s of the conversation that was nothing was found that could be, or at least appeared to be. Serious and problematic. That was going to cause me a real difficulty in the future, which is, I think, I guess, the question that most people want to know right off the bat that there’s nothing there are no serious findings.

Radiologist: And then looking at the pancreas itself, on these two images here, this is this is the head right here.

Peter Bowes: Yeah.

Radiologist: This is the neck, body and tail. So it goes all the way across the abdomen here. Right and again, I don’t see anything concerning in terms of a worrisome mass other than these, just these low risk cysts that will.

Peter Bowes: But for anyone aged I’m 62 that they’re inevitably going to be things that you see and you spot that maybe warrant some follow up with your doctor. And there will be 1 or 2 things that I’ll talk to my doctor about. But I think I’m, I’m in that that big category that you refer to, that really there were no significant findings that I should worry about, and perhaps 1 or 2 things that I should keep an eye on. And it was interesting to me that there were things that were observed that clearly tallied with my own knowledge of my medical history. You could see that. You could see again, very graphically, some of the results of some of the surgeries, for example, that I’ve had in the past. So I guess coming out of it, for me, obviously there’s that reassurance that there’s nothing seriously wrong with me, but it does give you that feeling of satisfaction that everything is okay and also a determination to continue with a lifestyle. And I think you reflected this from your first scan – a determination from what you’re seeing, that you need to do everything possible. We’re talking the basics – diet, exercise, sleep to maintain that healthy body that you seem to have at the moment, while understanding that this isn’t a scan for everything and that there are still some gold standard scans. And you can explain this to me like a colonoscopy. Like a mammogram for a woman, that you should still have to be absolutely certain about particular parts of the body.

Andrew Lacy: Yeah. No, I think that’s a great summary. And I was going to ask you what was the peace of mind like? And were you one of those folks that always had a little niggle in the back of your head that you were concerned about something? Or, you know, you know, and, and if so, was that this something that really changed your outlook around your health?

Peter Bowes: Well, I’m somewhat you know, I do this podcast. I’m interested in longevity. So I think, maybe almost to an extreme compared with most people, I am very interested in personal health and the interventions that we can do to and I mentioned sleep, diet and exercise as being absolutely the key interventions that we can all apply to ourselves. So I’m very interested. And there was nothing there were 1 or 2 things that I was concerned about that actually this scan did highlight and I will eventually talk to my doctor about, but that wasn’t, I mean, the reason I did this was because you offered it to me. We met at a conference. We talked about it. I moderated a conference, debate. And that was the …So the key question here is, would I have done the scan off my own bat? And we should say, and we haven’t mentioned yet, it costs 2500 dollars. So out of the range for most people, and certainly the price tag would make me think twice. And maybe I wouldn’t have done it because of of that significant outlay. And I think the question, the debate for most people, is it worth it? Is it worth paying 2500 dollars for what is based on your statistics, what is likely to be a peace of mind situation?

Andrew Lacy: Well, I mean, for let’s call it 90, 85 to 90% of people. Yeah. I mean, it’s peace of mind, and that –  a lot of people would consider that priceless, particularly if you have family history or you’ve previously had cancer. I mean, our health system, you know, if you if you have a breast cancer, for example, they they patch you up, you get treated. And often times there’s not a lot of follow up that happens in the years since. And and as an individual you’re always looking over your shoulder. So I think for many people peace of mind is really important. If you feel pain and you’re not sure what it is, and the health system is sort of ignoring it, knowing either what it is or what it isn’t. Also, it can be tremendously relieving. And then for the small set of people where we find something early, I mean, that’s really, those are the folks that sort of are grateful for the rest of their lives. And, so it’s obviously it’s a complex question. It’s expensive. We’re working hard to bring the cost down. We actually have a cancer screening exam that costs $1,000. So, that’s much less expensive. If folks are mainly concerned about cancer, um, I believe one day in the future, these scans should be three, four, five hundred dollars covered by insurance and part of the health system. And that’s the future that we’re working towards. We? When we started Nuvo, we never said that we wanted to build something that would be, you know, just sort of concierge medicine. We wanted to build something that could really change the world. And that’s what my. Team is really focused on doing.

Peter Bowes: How close do you think we are to that? Because at the moment, as you imply this, the insurance companies will not cover this kind of testing. Are you in discussions with insurance companies? What what is your sense of how close they are to, in terms of a meeting of minds that this would be a beneficial intervention for most people?

Andrew Lacy: Yeah. Our philosophy as a company really has been, first and foremost, how do we bring the cost down assuming it’s not covered? So what can we do here? And, you know, there are three things that we’re working on. One is, bringing down the time it takes to screen you. Obviously, the machines are very expensive. The facilities are expensive to operate. So the faster we can, bring people through, the screening process, the more people we can get through, the more we can spread those costs across more people. The second is just through scale. We operate in Los Angeles, for example, an MRI center that has five machines. That’s probably one of the biggest, the biggest centers in North America. So these MRI facilities are not are not operating at very big scale. And we believe as we build bigger and bigger centers, that we’ll be able to bring the cost down. And then the third is to use AI, frankly, to help make the radiologists more efficient. And here I believe there’s a lot of promise, the radiology is the most expensive cost in these procedures. So we’re working on all three of these. And we hope that that will bring the cost down. For every $100, we can take off the cost. You know, the market becomes bigger and more and more people can access it. But also the cheaper the exam becomes, the more likely it will be covered by insurance and health systems anyhow. So I hope that ultimately the goal is it’s covered for everyone. But you know, as a company, we’re working to bring the cost down as much as we can so that if that takes time, at least more and more people can access it.

Peter Bowes: Just to dive into the AI thing, at the moment, all of the scans are reviewed by a human being, by a radiologist. Do you do you involve any AI at all?

Andrew Lacy: We do. We have some AI involved in speeding up the image acquisition to some extent. We have AI that helps us understand what’s happening with the volume of certain organs, particularly as we scan people longitudinally. That can tell us a lot about underlying health conditions and just underlying trajectory of health. Obviously we’re working on a lot of models too, that are diagnostic models. So training AI to help really get to the point of being able to diagnose various medical conditions. And here the challenge really is, you know, we need to make radiologists much more efficient. Because if we did want to offer these screenings at population scale, unfortunately there’s not enough radiologists. You know, probably in the world to do that, even just in the US. So, whatever to do this at population scale will require AI in one form or another just to make that feasible.

Peter Bowes: And of course, this is a massive growth area in the health sphere. If you look at clinical trials, the use of AI to analyze mass data is I mean, it’s revolutionizing science in so many ways.

Andrew Lacy: Well, it’s funny, we always think of AI as being very, sort of, this kind of like unique solution. It’s funny, we live in a world of chat, you know, chat GPT and OpenAI and, you know, I have a young child. And so you just see the way a child learns and you sort of start to imagine it gives you a great appreciation of how AI learns to some extent. And, even with medical imaging. So, you know, what makes a great radiologist? Well, they’ve looked at thousands of studies in the past, and they can sort of apply the sum total of that knowledge to the case right in front of them. And really, that’s what AI is doing. It’s evaluating thousands or tens and thousands of studies and then being able to say, okay, you know, based on all of the brains I’ve looked at before that, you know, I knew what what they were diagnosed with. When I look at this brain, this is what I’m seeing. So those models obviously benefit from having more data. And as we continue to grow, there are more and more medical diagnoses that become sort of low hanging fruit. There’s enough data that’s available in order for the algorithms to do a pretty good job of diagnosing. And always there’s the radiologist there to, you know, make sure that there’s a human in the loop, which for us is very important.

Peter Bowes: Let’s just talk about some of your positive outcomes. You’ve touched on this, but can you give me some examples? We talked about the range of findings from a potentially life threatening condition to something that maybe just needs to be monitored. Or something that’s just nothing at all. What about those examples where you have quite literally helped save someone’s life?

Andrew Lacy: Sure. I mean, we’ve, there’s been a number of public cases. We found a pancreatic cancer in Maria Menounos, who’s quite well known personality in the US. We have lots of sort of unsung heroes that we’ve found stage one or stage two early cancer out there in the communities, and what we see happen is. You know, we see these clusters of patients coming into us from certain suburbs and oftentimes the sort of like the genesis of that is that we’ve made a life saving diagnosis and that’s got around the community, and then new folks come in, be it sort of a geographic community or a school. You know, the parents start coming in because we find something. So, I mean, we’ve probably found now thousands and thousands of cancers and aneurysms, leading to life saving diagnoses.

Peter Bowes: The key being you would find a stage one cancer in a particular organ at a stage where it can be operated on. The cancer could be surgically removed before it. And I think this is the key before it has spread outside of the source organ, before it is affected other parts of the body.

Andrew Lacy: Yeah. I mean, the the thing that we, we need to bear in mind is there are only 3 or 4 standard of care screening modalities for cancer, and that helps us catch about 14% of all the cancers that we can find. So 86% of cancers are not found in routine screening. And in the UK, there was a study that showed the vast majority of those cancers are caught in an acute setting in the hospital when the cancer is already advanced. So, you know, Prenuvo’s philosophy in some ways is almost like no organ left behind. We want one screening test that is does a good enough job, in some cases a great job depending on the part of the body of screening every single organ for everything that we can see. And if we do that, then we’re going to find things that are in patients where they’re still asymptomatic. And in many cases, those are life saving diagnoses. And I’ll give you two examples. The first example is we are seeing for reasons which are not well understood, we’re not the only people seeing this. They believe it’s maybe environmental, that we are seeing an increase in lung cancer in young women that have never smoked. And when we have found it thankfully these have been stage one. And successfully resected and absolutely lifesaving because lung cancer is a very, very deadly cancer. Another example is ovarian cancer. The challenge with ovarian cancer is that women obviously, premenopausal women, they have periods all the time. They have pain down there. And as a health care system, we often ignore abnormal pain. We write it off as, you know, something that women are expected to have. And ovarian cancer is so deadly because it’s typically caught when, it bursts from the ovary and basically fills the abdominal cavity. And that’s just, you know, that’s, you know, a horrible situation with very poor sort of expected outcome. Most of the ovarian cancer we’ve caught has been stage one limited to the ovary. And so, you know, we should remember that other 86% of cancers, which there isn’t screening. And, you know, we want to make a dent in those while still acknowledging that people should continue to get the standard of care screening that is covered for by insurance.

Peter Bowes: Yeah, I was going to raise that point that, again, you can’t emphasize enough that this is if people choose to do it. This is an add on to the other types of screening, whether it’s a scan or a blood test or whatever they would get from their regular doctor, that this isn’t a 100% catch all. And that people I guess you tell people this, this don’t be lulled into a false sense of security. We’ve talked about that feel good feeling of being told that you’re you’re doing okay and that there’s nothing, at least in the scan, that suggests that you have any fatal, potentially fatal conditions. But but this isn’t everything. And that those gold standard tests are still important.

Andrew Lacy: Yeah. I think the biggest, I think most exciting outcome of the scan that I see in patients that I interact with every day is just being able to see the images as kind of a catalyst for change. And I remember in the very early days, we had a young software engineer who was a smoker and, you know, all of our employees at Prenuvo, we get scanned once a year. And so we put this person in the machine. And of course, he knew theoretically that smoking was a bad thing. And at some point he should give it up. Maybe he tried a few times before, but we took him out and we showed him. Okay, see this white in your lungs? This is inflammation from smoking. And this white is in exactly the place where cancer likes to start in the lung. And just being able to show someone that picture. As a catalyst for positive change, or someone that might have high blood pressure and you think, oh, high blood pressure. What does that mean? You know, it’s like such a it’s something that you can’t grasp, you know, without it’s just a number on a report. But we showed the end organ damage to the brain from high blood pressure. We we can show, like, the little area, little patches of, damaged brain tissue because you might have high blood pressure or cholesterol or… So these pictures are real catalyst for change in health trajectory. You know, sometimes that’s learning something that you don’t have. Sometimes that’s learning that you don’t have something you thought you had. But you can’t escape from a picture tells a thousand words. It’s there, it’s in your face. And at least for me, it’s always been a catalyst for, you know, making positive change. I now spend two hours a day on a walking treadmill desk because my cervical spine, like most people from Silicon Valley, you know, was ruined by spending too much time sitting at computers and looking at phones. And I now walk about six miles a day. And my spine, the condition of my spine has not only not progressed, but it’s got better. And that all came from looking at a picture and saying, Holy cow, you know, that doesn’t look good. And maybe, you know, pretty soon we’ll probably have AI that will tell you, okay, if you keep doing what you’re doing, this is what your spine is going to look like in 20 years. And hopefully that, you know, that’s going to be a real catalyst for change.

Peter Bowes: Interesting, isn’t it, how technology can help to inform us or tell us that some of the most basic of interventions are probably the best for us? Like you’ve been informed that constant movement, or a lot of movement during your day can be ultimately very good for you. I’m curious what you would say, Andrew, to those people who say, I just don’t want to know. I wouldn’t want to have one of these scans because I would rather. And you hear it? Well, I’ve heard it quite a lot. I just rather not know. I’d just rather get on with my life and not know. Now, clearly at your facility, you probably don’t interact with these people because they don’t come to you in the first place. But what would you say to them?

Andrew Lacy: Well we do, I mean, oftentimes how that works is the that usually it’s the wife that comes in first and she has a great experience. And then she drags the, you know, husband in by the ear. And I don’t know, it’s this is sort of we this is the sort of a weird quirk of human nature that we don’t want to know. You know, at the same time, we’re the first person to tell a friend, hey, you know, like, you don’t look healthy, go and get checked out. But we don’t see, see that same need in ourselves. I think the most scary of these scans is the first one, because the first one is sort of you having been. It’s like not it’s like going to the dentist, not having been for like 3 or 4 years. You know, the likelihood that you’re going to have a root canal is probably a lot higher than if you go every six months. But we now have patients that come in routinely every year or two. And it’s not a scary thing. It’s additional knowledge, to help them live their lives better. The likelihood of anything really crazy coming up is quite low and intentionally so if you do it routinely. They know that if anything’s caught, it’s going to be caught very early because it wasn’t there was nothing on the scan the year before. So the challenge is getting over that initial, I would say hesitation. And then once you do that, the hope is that you can sort of outsource a lot of your anxiety or concerns about health to companies like Prenuvo and other people that are operating in the perennial health space.

Peter Bowes: And I think it’s fair to say that some people might be motivated to come to see you and to have one of these scans because they’ve read or seen a celebrity endorsement in social media. And I’m just curious to know what how you feel about that. I know clearly it motivates some people. For others, it can have quite the opposite effect, that it can be a turn off that a celebrity has said something. Therefore, should I do it? And the reaction might well, no. What do they know? Do you embrace what celebrities say?

Andrew Lacy: Well, yes. And it’s almost never completely the deciding factor. I would say for most patients that come in, health care is a very … it’s a high trust, purchase. And because these scans are not inexpensive, it’s a very considered purchase. And so most people are coming in, have heard about us from two, three, four different locations. So that might have been they heard an influencer talk about us. They had a friend that came in and had a great experience, a colleague at work. They found something and they’re very grateful. So it’s a combination of these things that help people, you know, I guess, like get up the courage to come in themselves. Having said that, obviously we’re very grateful for celebrities because the biggest challenge when you’re building something new and transformative is just word of mouth and having people really understand that these are the tests are available and might be relevant to them. And so celebrities have big audiences and we’re excited every time that you know they themselves are excited to share their experience with their audience and hopefully save lives. So, it’s absolutely not the only factor that most people take into account, but absolutely, we’re really excited to continue to lean into that, because the more awareness there is, at least the more people out there have the possibility to consider whether this is right for them.

Peter Bowes: Well I Andrew, I’m going to follow your work with interest. Certainly looking out for that additional research that we talked about earlier, that may well show that you’re doing a fantastic job and more people should have scans like this. I will follow the criticism of what you are doing as well. And we’ve talked about it during this interview. I’m hoping to speak to someone, a radiologist, maybe that has an opposing view, and put some of your points to that person, because I think it is important, and I would hope that you would agree with this that these discussions are had, that when something is controversial like this, that we really do dive into to all sides to get a full picture as to whether something like this is going to be beneficial for most people. And I always come back to the idea that we are all hopefully ultimately working on the same side here. We want better health for everyone.

Andrew Lacy: Yeah, I think maybe just to close off on that, look, there has been a history of whole body screening over the last 20 or 30 years that has not been great. About 30 years ago, you could go to a shopping mall in the US, and there were companies that put you inside a CT machine that was not low dose, that would screen you for cancer. And the only thing we know for certain is if you did it enough times, they would probably find cancer. What we don’t know is whether they would have caused it in the first place. So the medical system has unfortunately … has a lot of sort of bad institutional memory for screening. And so a lot of the challenge on Prenuvo and other companies in the space is really to help educate folks on how the modality we’re using is different. The imaging techniques are significantly more advanced. And it’s important to really recognize that these exams or similar exams to what we’re doing are already considered best practice for many areas of medicine, for people that have a high genetic risk of cancer, like Li-Fraumeni Syndrome. These people are getting whole body MRIs every year. In certain markets in Europe they’re used for patients that might have had certain cancers to make sure they don’t come back. Again, part of standard of care. So the exam itself actually has a lot of clinical support. The real question here is really a question of cost versus benefit. Which again is a question that is should is a different sort of question when you apply it to the individual as when you apply it to the population. And I think that’s what the, you know, that’s the evidence that it still needs to be gathered.

Peter Bowes: Indeed. Andrew, really good to talk to you. Thank you very much indeed.

Andrew Lacy: No worries. Thank you Peter.


Dr. Mirza Rahman: This interview was recorded on June 7, 2024 and transcribed using Sonix AI. Please check against audio recording for absolute accuracy.

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Dr. Mirza Rahman: We want to make sure that the people in this country are able to live long, happy, healthy lives. Healthy People 2030 talks about improving the quality and length of people’s lives. So we all have the same goal. We’re not at odds over that. What we may disagree on is the substance of the matter, which is, yes, MRIs are safe. Yes, they are effective at addressing specific issues. But what you’re talking about is something that is completely different than the way in which these scans were meant to be used. They weren’t meant to be  used as full body scans. The various risks that are attendant with this need to be addressed. And let’s talk about the benefits. If you find these benefits, nobody would be happier than us to get patients to a point where they can use this in a safe and effective manner to have a long, healthy life.

Peter Bowes: Is it worth having a full body MRI scan to screen for early signs of medical problems? Hello again, I’m Peter Bowes, welcome to the Live Long and Master Aging podcast. In our last episode, I told the story of my experience undergoing an early screening scan. I spoke to Andrew Lacy – the founder of a company called Prenuvo – who explained why he decided to build a company that offers people a full body MRI scan as a tool to catch potential conditions, such as cancer, so that they can be treated early.

Andrew Lacy: I went and did that scan, the same scan that you did, last week and, sat down afterwards and went through every single organ of my body. And I felt like I was meeting myself for the first time. I learned that there was nothing crazy serious that was happening under the skin. But I learned a lot of practical information about how I can make small adjustments to my lifestyle that hopefully will change the trajectory of my life. And as soon as I went through this process myself I sort of fell so in love with it that I just wanted to work harder, even still, to bring this to as many people as possible and that, you know, the fruits of that labor is Prenuvo. And the clinics that we’re building across North America.

Peter Bowes: There is strong opposition to such scans from medical bodies, including the American College of Radiology, which says there isn’t sufficient evidence to justify recommending total body screening for patients with no clinical symptoms, risk factors or a family history suggesting underlying disease or serious injury. In this episode, I want to explore those arguments further with doctor Mirza Rahman, the president of another professional body representing board certified physicians, the American College of Preventive Medicine. Doctor Rahman, thank you very much for joining us.

Dr. Mirza Rahman: My pleasure, Peter, thank you for having me on.

Peter Bowes: And before we dive into this issue, I just wanted to ask you about your organization. You represent over 2000 physicians and other health professionals. What is the main purpose of your organization?

Dr. Mirza Rahman: The American College of Preventive Medicine was set up 70 years ago. We just celebrated her 70th birthday at our annual meeting in Washington, DC last April, and this organization was created to help to improve the length and quality of life here in America. What we do is we have, as you said, about 2000 physicians who are board certified or in various stages of training and preventive medicine. And these physicians are the ones who work on a population based level. So the difference is when you go see your family doctor, she or he takes care of you in the room. When a preventive medicine physician is at work, she or he is caring for a population. It could be at the state level, it could be at the national level. These are the physicians who were primarily at large agencies, whether it’s a state health department, a county health department, or organizations that we’re all familiar with, like Centers for Disease Control and Prevention or the Food and Drug Administration. So the preventive medicine physicians have that responsibility for a broad group or broad population groups. And so that is what we do.

Peter Bowes: Would you like to see more emphasis on preventive medicine here in the United States? Indeed around the world.

Dr. Mirza Rahman: I think around the world, we would love to see more starting, of course, here in the United States. Unfortunately, a quirk of funding the preventive medicine, residents and residency training programs are not funded like all the other residency programs. So when you think of family medicine or surgery or OBGYN, these are funded through Medicare and preventive medicine, unfortunately is not. It is something we have been lobbying Congress to change. We need to get more preventive medicine-trained physicians out and working. There are lots of folks who want to come and do this work, but you don’t have we don’t have the requisite funding to do this. And, you know, you talk about having more preventive medicine physicians. That’s really vitally important because as we saw with Covid, diseases don’t respect borders. And so you don’t need a visa to come in. You’re British. I was born in Guyana in South America. It doesn’t respect borders. And so we need more of these types of physicians. And unfortunately, almost every time we go and talk to politicians to try to get them to support this, this is not changed. And it’s something we need to continue to do. It needs to be a fundamental transformation of how we fund and develop the field of preventive medicine here in the United States.

Peter Bowes: And what is your own personal experience as a doctor? And maybe without going through the full biography, just give me a sense of what’s brought you to this point in your career.

Dr. Mirza Rahman: Sure, I’ve done maybe three different things if I think about it. I’ve worked initially in public health. I was a medical director of a community health center in Long Island in New York. Subsequent to that, I went over into academics, and I worked for a while at Case Western Medical School as faculty in the Department of Family Medicine, and also epidemiology and biostatistics, before leaving about two and a half decades ago to join the pharmaceutical industry, where I’ve worked at a number of companies, primarily in pharmacovigilance, which is just a fancy word for saying drug safety. So I’ve worked in that area, and that actually ties nicely to what we will be talking about. It’s doing an assessment and an ongoing basis of the benefits and risks of the drugs or vaccines or devices that we work in. And as part of my professional engagement, I’ve been engaged with the American College of Preventive Medicine since I was a resident at the Stony Brook University School of Medicine in their preventive medicine residency, all the way back to 94 or so. It’s been a while.

Peter Bowes: So let’s dive into this subject then. MRI scans, magnetic resonance imaging. These are scans that have been around and have been widely used in medicine for a very long time, but there has been in recent years, an undeniable surge in interest in them as a screening technique for people who don’t have any previous symptoms, or indeed, a family history that could suggest the that there are potential problems. Now, you have written about this extensively on your organization’s website, and it is very clear that you and many others believe that these are not an appropriate form of screening for otherwise healthy people. Let’s just start at the beginning with your initial reservations and thoughts about the way in which these scans are being used.

Dr. Mirza Rahman: Well, when this first came up about nine, ten months ago with an influencer who talked about this and got a lot of media coverage, we had gone back in August of ’23 and looked at this, and I wrote an article in our newsletter talking about health care, Too Much and Not Enough. Going back to the 1930s, there was a report on the challenges with the delivery of health care in America. And in that report it was stated that the wealthy got too much of it and the poor didn’t get enough of it. Gets again to issues of health equity. And yes, while we can talk about anecdotal benefits and patients who have benefited from this, as I talked about in preventive medicine, we look at a population health basis. Does this work for the population and does it work on several levels? And what are the risks of these types of body scans. And this is what we don’t hear enough about from the purveyors of this. And, you know, maybe, to be a bit controversial, but maybe not to be too harsh, these purveyors of these types of scams, they not only don’t talk about the risks, but they sell lots of potential benefits. And in many ways, I think of these as this century’s equivalent of last century snake oil salesman. You’re talking about things that have no proven benefit on a population based level. I’m not talking about individually. You can always find the individual who has had something found on a body scan, but if you look at it from a cost effective standpoint, if you look at it from a benefit risk standpoint, what is the evidence? Is there any evidence these companies, the one you mentioned has been around, I think for the last six or so years, I think 2018, they came up. Have they generated any evidence that can be reviewed to show that there is a concrete benefit on a population level for what they’re doing, or is it simply a way to generate revenue? Who is this targeted to? Is this targeted to the general population or the population that we refer to as the worried wealthy, well, white individuals who have money to dispose. And they get back to that 1930s statement that the rich get too much of health care and the poor don’t get enough.

Peter Bowes: You’ve covered a lot of, as you describe them, potentially very controversial issues there. Let me focus on risk, which you talked about, and the the lack of discussion about risk. As you see it. What are the risks?

Dr. Mirza Rahman: Let me take just a minute to give you a primer on epidemiology. And when we talk about risk, there are six things we should think about. What is the sensitivity of the test? Because we know disease doesn’t occur randomly, right. If you’re going to talk about heart disease, for example, do you smoke? Do you have a family history? Is your cholesterol elevated?  Do you have diabetes? Are you sedentary? Things happen. Disease occurs in a non-random way. You have to have certain risk factors. And the purveyors of these MRI body scans are saying you should come and get a body scan, and the more is better, right? Let’s do it every six months. I saw somebody at one of these companies talking about doing more of it. What are the attendant risks? So sensitivity says a test when done if positive that is the sensitivity. So 90% of the time 97% of the time you do a test and it’s positive you will have that disease. Specificity says if you test and you don’t have the test is negative, then there is a 90%. If that’s the specificity that you don’t have the disease, then we come into the parts of risk that you asked about. If you get a false positive, that’s a positive test, when you don’t have disease. We’ll come back to what that means. False negative is you have a negative test and you in fact do have the disease. And then there are two things that we talk about. Positive predictive value. What is the percent of true – of true positives over all positives. Because remember now you have false positives. And this last point is the one that’s important. You need to understand the prevalence that is the underlying level of disease. The higher the prevalence, the better your positive predictive value. But if you’re scanning for things that are unknown in the entire body, you’re going to have a very low prevalence. You’re going to have mostly false positives. You will have thousands of needed follow ups. And when we talk about risk, this is where we get to it. The risk are financial. And maybe if you’re wealthy and you’re going for these tests it doesn’t matter. Right. But these are expensive tests to begin with and you may need more testing. The additional testing for the false positives, even the true positives. Right. You’re going to have to spend more money. You run the risk of injury. You run the risk of significant medical invasive procedures that can lead to complications, morbidity, more problems, mortality even. Right. What about the anxiety? What about the emotional impact on that person and their family when nothing may be wrong with them? You just find something that the radiologist, if you’ve spoken to them, refer to as an incidentaloma. It’s just incidental. It doesn’t mean anything. And what about the adverse events? The FDA on their website had about 300 cases of burns with the use of MRI machines last year. And then you get down to that favorite American thing that we have, which is litigation. Are we going to be prepared for the litigation that ensues from these types of things? And then the last thing is for patients, because we talk about focusing on patient safety, are you in fact doing tests then give people a false sense of security that they don’t go out and do the hard things, which is, as you point out in your podcast, exercise, sleeping appropriately, eating nutritious foods, de-stressing, having, connections socially and then not using inappropriate substances. So I’ve had my my MRI body scan that it came out all negative. I don’t even need to go for any more tests. I’m not going to go for my mammogram or my colonoscopy. I don’t need to check my cholesterol because the doctor said when I did this MRI scan, everything is fine. So you don’t do the right things that you need to do to live this long, happy, healthy life that we all aspire to do. And getting more of these types of scans is going to cause potentially more problems, because will they, in fact be increasing the risk of getting cancer? You know, in your podcast you talk about putting patient safety first, right? As long live and Master Aging podcast, you want to put patient safety first. Is this being done or are we lulling people into a false sense of security, where they, in fact may be worse off for never having gotten these scans?

Peter Bowes: So you talk about and you use the word risk in a very broad sense, covering a number of potential outcomes just in terms of risk of having an MRI. Now, clearly people have MRI scans in many situations. They may well have symptoms. It may be an appropriate kind of scan based on what their doctor has observed about their current condition. And for and you tell me, for the vast majority of people having an MRI scan, just having the scan is I mean, you talked about the potential for burns in a, I think, a small number of people, but generally an MRI is a safe procedure.

Dr. Mirza Rahman: There is no question that an MRI is a safe procedure, otherwise we wouldn’t be doing them. And we do tens of thousands if not millions of these procedures. I’m a runner. I injured my knee once, so I’ve had an MRI of my knee. That is focused medical care that is not screening from head to toe with an MRI. So think of the difference between a problem that needs to be addressed, a knee injury, versus a total body scan. The amount of radiation is entirely different. Correct. Because you’re not focusing on one area and then you’re not addressing a problem. You’re using it as a screening tool. That is. Up to now I have not seen any evidence. You know, I’ve worked for the last, as I said, 25 plus years in the pharmaceutical industry. And for us to bring products to market, we need to prove that they’re safe and effective and MRIs are safe and effective. Otherwise they wouldn’t be on the market. The FDA would not approve them, but they’re safe and effective when used as directed. So you’re looking at a problem. These companies that have been around the one you mentioned for about the last six years, what evidence have they generated to show that full body scanning is safe and effective? Has that data have those papers, if any, been reviewed and published anywhere? Have they been sent to the US Preventive Services Task Force, which reviews these types of things on an ongoing basis? They say, you know, you should get cholesterol screening. You should get blood pressure screening at some point. What is the evidence? And if you’re a company purporting that this is a great thing and everybody should get it, and I don’t get it, but maybe get it every six months, what is the evidence that has been generated in the last six months to show that the specific use that you’re pushing is worthwhile doing?

Peter Bowes: I just want to check that I heard you correctly just now. Did you just refer to the amount of radiation used because clearly MRIs don’t use radiation?

Dr. Mirza Rahman: I misspoke, I was thinking of CAT scans. That’s correct. Yes. No, no, I was thinking of CAT scans when I said that. But when you have an MRI, it is not the radiation as you know, it’s nuclear magnetic resonance imaging. But you do run the risk of burns. And that was in that FDA report that I talked about.

Peter Bowes: So maybe we should just clarify just in case anyone is confused, the difference between a CAT scan or CT scan and an MRI.

Dr. Mirza Rahman: So CAT scans and MRIs are slightly different. They do look at the internal body and without having to do these invasive procedures. But CAT scans use radiation and MRIs Magnetic Resonance Imaging use a different type of waves to get to the visualization that we can see of kidneys, liver, etc..

Peter Bowes: So we’re not talking about the dangers of radiation in this discussion with MRIs. And I think it is obviously worth making that clear. Let’s talk about one of the the risks that you refer to being false positives or indeed false negatives. Let’s just elaborate on exactly what a false positive specifically is and what it could lead to.

Dr. Mirza Rahman: So if you have a false positive, let’s sort of move away from, let’s say the body scans for a second. Let’s do something different. You have 30 year olds and you have 65 year olds. And we could easily do a treadmill test on them. You know, when you’re looking to do cardiac testing, right? So you’re trying to screen, you could easily say, let’s screen for coronary artery disease. Or let’s do mammography on 20 year old girls and 60 year old women. The difference is that when you use the mammogram or you, have, the tests for coronary artery disease, the stress testing, if you look at a 30 year old versus a 60 year old, the difference and the likelihood of the prevalence of underlying coronary artery disease is going to be entirely different in those two populations. So while the sensitivity and specificity of the actual test may remain the same, the fact that you have a different amount of disease, we call it the prevalence existing will change the positive predictive value. And because of the testing that you have, you’re going to have a lot more false positives, and you’re going to require a lot more testing for people who don’t need it. So every test that turns out to be positive in the third year old versus the 60 year old is less likely to actually indicate disease. And that’s where we talk about the positive predictive value. So you’ve got a positive test in a 30 year old that is not likely to indicate actual disease. And that’s your false positive. But then you still have to undergo potentially more testing. And that’s why these things are based on risk screening. Tests are based on risk. Otherwise we could just say, well, everybody should get everything all the time. And without thinking of even the financial constraints of the medical system, how would you be able to follow up on all of those false positives that come forward? And so thinking about this and now looking at it at the MRIs, when you look at the MRIs that you’re talking about, full body scan, what is it that you’re going to find in 20 year olds, 30 year olds, 40 year olds, 50 year olds? And then just because you find something, it may not mean anything. What does it mean? And even our friends who are the radiologists, they may not know what these things mean. As you start to do all of these things, yes, in time they will get a sense of, okay, that’s not an issue or so on, but think of the incremental costs to the to the health care system. And yes, for the most part, I know these things are not covered by insurance. And so people are paying and, you know, it’s when we talk about cars and safety, you know, do you drive, do you buy a cheap car because you need to get around or you buy one that has lots of safety features? Well, if you’re wealthier, you can afford that, then you can do so. And maybe this is. And I’m not saying people should never do this. This is the United States where you can spend your money pretty much however you want. But does it make sense for you as a patient, as a consumer, to spend your money in this way? Or does it make sense to do the hard work, which is the things we talk about in lifestyle medicine and preventive medicine? Get the appropriate screening things, get the do the primary prevention, eat nutritiously, exercise, sleep. You know, avoid sugar, salt, caffeine, drugs, alcohol and make sure you’ve got the right social connections. But those things are hard. And we choose not to do the hard things because they are, in fact, hard. When we can spend money and feel, even if incorrectly feeling safe, is what, how we feel.

Peter Bowes: And going back to these false positives. In other words, finding something that eventually, even if there is further testing it is generally agreed isn’t a problem. It isn’t going to cause you a medical problem in the future. Is it fair to say often referred to as the incidental findings that occur as a result of these MRIs, is it fair to say that pretty much all of us are walking around at any time, at any age, with many of these incidental situations occurring in our body? In other words, there’s no time that we are all 100% that you might describe as being fully healthy or normal. There are always going to be these little quirks that ultimately aren’t going to be of any significance to our overall health.

Dr. Mirza Rahman: I think that is entirely true. And the more and more we get these types of scans done, the more and more we will find things out that we won’t need to worry about. But at first, we will start to worry about them. I think one of the best examples of this right now is when we talk about prostate cancer. In the United States there had been recommendations that have since been changed about screening for prostate cancer, per the US Preventive Services Task Force. And the thing about prostate cancer that we have learned over time is that by the time you get to be 70 and 80, most men will die with prostate cancer instead of having died of prostate cancer. So you have it. It’s benign, it’s slowly growing. And it doesn’t matter because you may have a plethora of other medical problems, including coronary artery disease, kidney disease, etc. but by the time you get to a certain age, we have various anomalies that exist within each of us that won’t bother us, won’t kill us, but they are there. Could you in fact go about doing everything and chasing down everything? Perhaps you can with enough money, but does it make sense? And how does it impact your health? Does it actually improve your health? Or is this sort of worried, well, going to the nth degree and being obsessive and then dramatically decreasing the quality of their health as a result of ongoing procedures, anxiety, complications and the rest?

Peter Bowes: Let me ask you about the difference between considering this issue at a population level, which you’ve referred to versus an individual level, because I think this is a part of the debate that some people might find difficult to understand because they are, by their very nature, thinking about their own personal health or the health of their loved ones. If they choose to have a scan like this, they are not necessarily immediately thinking of of the implications at a popular level, the fiscal implications. How would you explain that to someone who is purely concerned about their own health? They maybe have nagging doubts about their health, and they feel as if a full body scan would perhaps help alleviate those worries.

Dr. Mirza Rahman: I think people need to understand that if they’re looking for things for themselves, they should also look at the evidence of its utility. You wouldn’t necessarily go out and do something that you just heard about just because it’s being advertised. And I think that’s the danger of this. This is being advertised. It is being pushed by influencers. There’s a lot of money to be made by these things. So there is an incentive for the owners of these organizations to push this forward. And even if you’re only looking at it for yourself, you wouldn’t necessarily do something just because you’ve heard about it. There still needs to be that discussion with your health care professional, and it’s incumbent upon us in the medical field to share with our colleagues the family, doctors, internists, OB-GYNs, etc. the primary care physicians, the physicians that have first contact continuous coordinated care with their patients to get them the evidence to say, look, there is nothing that says this is necessarily beneficial. You can obviously find anecdotal anecdotes about, oh, I went and I found this tumor and if they hadn’t done the surgery, this would have been a problem. But if you’re somebody going in, you need to understand what are the risks, and the risks are greater than the benefits. And I think if any of these corporations felt that they had great evidence, they would put it forward. In the pharmaceutical industry, I think I may have mentioned, you’ve got to have two randomized, well controlled trials before you – proving safety and efficacy. Has that been done? Will that be done? Because the trick here is that, you know, that MRIs have been approved. They are safe and effective if used to determine certain things. But this is an entirely new use case that is being put forward for which there is no evidence. And so when you talk about this, you can get anecdotes. And if I’m a patient going in I’m going to talk with my doctor. So Doctor Bose can you tell me, should I have this? The physician, then she or he needs to be equipped and knowledgeable about the risks and benefits of these. So let’s say somebody has had coronary artery disease in their family, their smoker or so on, you know. There’s something that, you know, you can do a CAT scan to check for coronary calcium. All right. But that’s been studied. And that has been proven to be worthwhile to do in certain patients. You’re not going to do it in everybody. But if there’s certain risk factors, what are the risk factors that somebody that a company can say you should get a full body scan. On what basis is this being put forward? And so as an individual going in to speak with your healthcare professional, she or he should be able to discuss with you. Do you have any risk factors? Are there other things we should do other than the full body scan? And that, I think, is a conversation that takes place with the individual patient in the privacy with their of the office, of their health care professional. And having that discussion is worthwhile. But then bringing in the evidence to support or refute the value of this is going to be important.

Peter Bowes: You mentioned earlier about the societal discrepancies in terms of the use of these scans. You referred to the the healthy wealthy, those people who, let’s face it, need to be quite rich to be able to afford something like this. And this isn’t something that is being used by America’s poorer communities or indeed poorer communities around the world. Is this affecting those communities in a negative way, in that it is being used by the to use the phrase that the healthy wealthy, and that it is requiring all of those follow up procedures as well, which presumably have to be paid for privately because they’re not covered by insurance. But my question is, is it doing any wider harm in terms of the health care of every community?

Dr. Mirza Rahman: So I think one thing to be clear is that while the initial testing may be paid for individually, if there is something that is found, then the insurance company to which that person belongs will probably be on the hook. So you are using the resources on a broader level. It’s not. It’s no longer of me paying for my body scan. I pay for my body scan. They found something on the tip of my right kidney. I take that to my doctor at one of the managed care organizations, and then they are now almost obligated to follow up on that, right? You can’t ignore a potential problem. In terms of what this means for the health care system and people who may be socially disadvantaged. You know, we talk about the social determinants of health, people who are in poorer communities, etc. you know, all the health costs are going to rise because of this. And we spend more money than any other country in the world for health. And this will likely cause an increase in this. So, you know, if this becomes used broadly by folks who can afford it. And in fairness, the costs have gone down from about $2500, maybe as low as a thousand may be less than that. But no matter what, if your people are spending money for this, they’re finding out things, then these things now have to be investigated. And whether they turn out to be true or false positives, you still have to spend that money. And the US health care bill will go up. And as it goes up, things that we pay for in Medicare and Medicaid, the various managed care companies, all of health care will continue to rise in America. And that then takes away from the ability to care for and provide care for the people who are at the lowest rungs of the ladder.

Peter Bowes: So the, at least one of the big issues here is the lack of research that would confirm that these scans used at a population level, are justified. I’m interested to know how close we are, do you think, to the research being conclusive, so that a majority of health professionals might agree that some element of body scanning, full body scanning for the general population is indeed justified? Utilizing the clearly the advancing technology and scanning technology, which does produce some extraordinary images of the inside of our bodies. Question being how close are we to a time when it may be justified to widen the net in terms of the number of people that have these scans?

Dr. Mirza Rahman: I think that’s a question best addressed by the people who own these companies and whether or not they’re doing any research. So I have no other comment other than that.

Peter Bowes: But from your perspective, you wouldn’t want to encourage wider research into these scans to fully justify or otherwise their use. You say the onus is on the private companies who are using the scans.

Dr. Mirza Rahman: The onus is on them. They’re the ones saying that this is what you should come and get. I’ve worked, as I said, at four different pharmaceutical companies. If we want to bring a new drug to market, the onus is on us to prove that these drugs are safe and effective. Similarly, if I’m the owner of a company that pushes, you know, that purports the benefits of body scans, full body scans, what are the risks? What are the benefits? Display it. You’ve had five six years of doing this. Show us the evidence because we need to remember, just because you can do something doesn’t mean you should be doing it. And you can do lots of things without evidence. You know, most of medicine before the last 40 or 50 years was practiced without evidence. It was see one do one, teach one. It was following what the university or your mentor or your guide did. But we need to get beyond that to a point where we use evidence. It was only until, you know, as recently as the 1960s you had to prove the drugs were safe and effective. I talked about the snake oil salesmen of yesteryear. It was only when there was a debacle, and there were people who died drinking and an elixir of sulfanilamide that we had to prove that things were safe. And that was in around 1910. Around the 1960s, you had the Kefauver Act, and you had to prove that it was safe and effective. Let’s prove that these procedures are safe and effective, and we would happily recommend them. I think we want to make sure that the people in this country are able to live long, happy, healthy lives. Healthy People 2030 talks about improving the quality and length of people’s lives. So we all have the same goal. We’re not at odds over that. What we may disagree on is the substance of the matter, which is yes, MRIs are safe. Yes, they are effective at addressing specific issues. But what you’re talking about is something that is completely different than the way in which these bodies, these scans, were meant to be used. They were meant to be used, for knee injuries, to stick with the example I used earlier, they weren’t meant to be used as full body scans. And so if you’re talking about that, the the various risks that are attendant with this need to be addressed. And let’s talk about the benefits. If you find these benefits, nobody would be happier than us to get patients to a point where they can use this in a safe and effective manner to have a long, healthy life. You know, we’re all looking to try to diminish chronic disease in this country. We’re at a point where, according to the CDC, 70% of American adults over the age of 18 are either obese or overweight. Should we be focusing on those types of things, as opposed to these body scans, where you may falsely reassure people that they’re perfectly in good health, when in fact they may have significant underlying issues that are not being talked about or addressed.

Peter Bowes: Just one final point on the risks, the many risks that you talked about. And that is the risk of worry and stress because there are false positives and further tests are required. And I’ve talked to people who have described going to, to quote, hell and back, during that period of time when they had to follow up on those additional tests for people who are considering this and thinking about it and perhaps are of the mindset that, well, yes, I understand those potential risks, but I still want to go ahead anyway. Is it the case that perhaps people might think they understand, but when they actually get to that point and those stresses and those worries actually hit them, that the impact is much greater than they thought?

Dr. Mirza Rahman: Yeah, I’ll quote that noted philosopher who said that you think you’re well prepared until you get punched in the face. Mike Tyson. We think we may know what will happen when we go for a test, because the assumption is we’re fine. But when you find something that little different, growth in the right kidney, all of a sudden your plans of going in and coming out and you’re being reassured, you’re fine, turn upside down, you get punched in the face, How do you react? And this is where the anxiety and the emotional toll takes its place, not just on the individual patient, but on their entire family. You know, father of four comes home and says, oh, you know, I had this body scan and they said. To have something now on my kidney. What happens to the next X number of weeks until they find out it’s nothing, right. And most of these cases will be a lot of nothings. But for that period of time, you’ve just been punched in the face. And how do you react and what toll does it take? And that is one of the significant risks that we don’t hear enough about. It’s usually we, you know, people go in you. The stories we hear about that are covered frequently in the news, in various media sources is about the lovely anecdote about somebody went in and if they hadn’t done that test, they wouldn’t have found this thyroid cancer. And luckily for her, it was biopsied and the surgery was done. And she’s perfectly fine now. You don’t hear about the tens of thousands of cases that may exist where they found something. The biopsy was done, it was benign, and there’s nothing more to do. How many of those cases exist that we don’t hear about? And I think this false equivalence that we need to hear both sides is complete and utter nonsense. We should start to tabulate or ask these, ask these companies that are pushing this, what are the numbers? Show us the data. Tell us how many people you had found something about and what was done and what was the outcome. And I think this is where we need to start from, start from evidence based decision making. And you can’t make that decision based on evidence if there’s a complete absence of evidence. And this is why the onus is on these companies, from my perspective, that they need to do the studies and demonstrate and show the data of what it is that they have done.

Peter Bowes: Having gone through this and I went into this very open minded and I would say and not going into all the details, but I would say I’m in that group of people that, yes, there were incidental findings, that there was nothing, at least that was observed in the scan, that was potentially a very serious condition for me. But there were incidental findings. Speaking as a 62 year old, that’s what you would expect. That’s what my doctor expected. That’s what happened. I’ve chosen not to follow up in future tests, any of those situations because I don’t. And again, having spoken to my doctor, don’t consider any of them to be serious. That is my personal decision, and I guess I’m lucky in that respect that I’m an otherwise healthy human being. There was one impact on me that was was notable and that was having. And I guess other people will experience this as well. Those that are told that, well, look, there’s potentially nothing serious, seriously wrong with you. And clearly that isn’t 100% conclusion because it could have missed things. But that being the conclusion, there is a sort of feel good factor there that oh, I’m doing okay if I continue with my healthy lifestyle. Maybe it’s an impetus to continue with your your healthy lifestyle. But just leaving that aside, one thought that has gone through my mind since going through this is that I just wonder if an equivalent amount of money was spent on health education. And as you’ve referred to what I talk about a lot is diet for your good health, exercise especially, good sleep, social connections. Those are the the key pillars of longevity for me. If an equivalent amount of money was spent on health education to promote those pillars of good health, to what extent could we improve population health if people took heed of those kinds of factors?

Dr. Mirza Rahman: But I think, Peter part of the challenge. So first of all, let me go back and say, look, I’m glad to hear that you’re doing well. And that must have been a scare. And I think if you multiply that through the thousands of people who go through these scares, for every one that you find something that’s real, it’s got to be, you know, assessed and recognized that this is a risk. And when we talk about education, you know, you’ve got the American College of Preventive Medicine puts forward lots of things. The American College of Lifestyle Medicine, which for the last 20 years and has grown significantly in the last ten years, they put forward a lot of these things. Much of it can be accessed freely by consumers, patients, etc. but it comes down to the hard work. The hard work is changing behavior and I am as guilty as anyone of it. So I run and and I do other things, stay socially connected, but I know that I don’t eat as well as I should. I know that I don’t get as much sleep as I should, but that’s the hard part, right? And while, you know, President Kennedy talked about when they were looking to go to the moon, we choose to do the hard things because it helps to organize our resources, and we’ll get to the moon by the end of the decade. We in this country and around the world find it very hard to do the hard things.

Peter Bowes: We do. That’s a really, really good point, but I think it is up to those health professionals working, especially in preventive medicine, to create the environment perhaps that makes it just a little easier to do the things that most of us find hard to do. And you’re absolutely right for all, for all. I talk about these things all the time. I’m not perfect either, and I will not eat the perfect diet. Maybe not get as the correct number of hours of sleep that I really need and would like to get. There are always areas where we can improve, and I think the challenge for people, not just people that talk about it like me, but the people who are actually helping us with the professional advice is to keep pursuing that. This is a slow journey, isn’t it, in many respects, to to get people to understand the things that are absolutely the best for us. And as I often talk about in terms of medical research and health research, it doesn’t happen overnight. And especially when you’re dealing with with populations and studies and clinical trials. I guess we’re all in this for the long game.

Dr. Mirza Rahman: It is. And I think perhaps one of the things I was listening to a book I had to drive back from Virginia yesterday. I was listening to a book. And really, if we start with the end in mind, recognizing no matter what we do or how healthy we are, we will all die. And I think the Stoics talk about this. So knowing that we will all die instead of having it to the back of our brain, maybe bringing it forward and having it more in the front of our brain, and then trying to do everything we can to maximize our quality of life and our length of life. And the way we do that is by those six pillars that we talk about in lifestyle medicine, and the way we also need to think about doing it, is to be better today than we were yesterday, and to be better tomorrow than we are today in pursuing these six elements of lifestyle medicine. Eating nutritious foods. I’m not saying you need to be vegan, I’m saying you need to eat more fruit and vegetables. Exercise. You don’t need to run a marathon, although that’s fine if you do. But if you go out walking for 30 minutes a day and so on and so forth. So these are the things if we think about, yes, we will die, but can we put that off for as long as we can and have an avoidance of chronic disease and stay healthy and active and independent and dance at our granddaughter’s wedding? Maybe those are the things that we will look to do, and how we get there is to be better a little bit every day compared to the day before, and look to work on these six pillars, and that will help us in the long run, as opposed to looking for what we love so often in America, and maybe around the world, is we look for the quick fix, quick, simple fixes. You know, I’m going to have my steak and I’m also going to take my statin because, you know, that’s what we do.

Peter Bowes: Doctor Rahman, this has been an enlightening conversation, hopefully very helpful to people considering this issue. Thank you very much indeed.

Dr. Mirza Rahman: Thank you very much, Peter, I appreciate it.

The Live Long and Master Aging (LLAMA) podcast, a HealthSpan Media LLC production, shares ideas but does not offer medical advice. If you have health concerns of any kind, or you are considering adopting a new diet or exercise regime, you should consult your doctor.

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