|
will a Full-Body MRI Scan Help You or Hurt You?
Companies like Prenuvo and Ezra will use magnetic resonance imaging to reveal what’s inside you—for a price.
By Dhruv Khullar
Ryan Crownholm, a middle-aged Army veteran with luminous green eyes and a strong jawline, likes to describe himself as a health hacker. He has written on LinkedIn that, after founding and running several construction-related companies, he started to think of his own body as a data source. During the pandemic, he attached a continuous glucose monitor to his skin, bought an Oura ring to monitor his sleep, and signed up for a healthy meal-delivery service. “I started tracking each of my data points,” he wrote. “I outsourced my diet.” Every few months, a pricey concierge doctor—“kind of my longevity guy,” he told me—sends his blood for comprehensive testing. To assess his bone health and body-fat composition, Crownholm gets regular dual-energy X-ray absorptiometry, or dexa, scans, which are normally recommended for older women at risk of osteoporosis. “Quantifying everything allowed me to be successful in business,” he told me. “I think it’s the same with health.”
One afternoon, while listening to a business podcast, Crownholm heard about a company called Prenuvo, which promises to help patients take control of their health. For twenty-five hundred dollars, Prenuvo will generate magnetic resonance imaging, or MRI, from your head to your ankles, and analyze the results for abnormalities. Images of Crownholm’s insides sounded like the perfect addition to his regimen; he signed up before Prenuvo had even opened a facility in Los Angeles, where he lives. “I felt great, but I wanted to know what might be lurking inside me,” he said. A few days after receiving the MRI, while he was in a meeting, his phone rang. The scan showed a roughly three-inch-long mass in his right kidney. “The doctor said, ‘We don’t know if it’s benign or malignant, but we better take it out,’ ” he told me. His kidney was cut out, and the pathology returned positive for renal-cell carcinoma, a treatable cancer that, in some cases, can be fatal. Crownholm credits the company with saving his life.
Crownholm is an unusual patient. He is wealthy enough to afford, and eager to use, a wide variety of optional care; he’s drawn to experimental technologies, whether or not doctors recommend them. He also had a dangerous tumor at a key stage: large enough to appear clearly in a full-body scan, but small enough to be asymptomatic and removable. In all of these ways, he was an ideal patient for Prenuvo. The company ultimately recruited him to appear in a promotional video, and he became a kind of MRI evangelist.
After Crownholm’s diagnosis, he sent around a dozen friends and family members to get scanned. None had a dramatic experience like his. “Pretty much all of them have found some sort of incidentals,” he said, meaning that their scans showed minor or ambiguous anomalies. Still, he argued that even if Prenuvo hadn’t saved their lives, the company had still given them helpful data: “At least, now, they have a solid baseline.”
As a doctor, I approached Crownholm’s story with caution. No professional medical society in America endorses whole-body MRIs as a proactive screening tool. The American College of Preventive Medicine argues that they “waste money and healthcare resources,” while the American College of Radiology, which theoretically stands to benefit from more imaging, said in a statement that “there is no documented evidence that total body screening is cost-efficient or effective in prolonging life.” Doctors tend to think that if it ain’t broke, don’t MRI it; for every case like Crownholm’s, there are many more that result in false positives, additional scans, needless biopsies, avoidable anxiety, and excess costs. And yet to hear Crownholm’s story is to wonder whether you, too, should get a scan.
Prenuvo was founded by a man who, like Crownholm, launched companies for a living and was happy to pay a premium for health care. In 2018, Andrew Lacy, a serial tech entrepreneur with an M.B.A. from Stanford, flew to Vancouver to get a whole-body scan from Rajpaul Attariwala, a Canadian radiologist who had purchased his own MRI machine for use on a selective clientele in his private office. (MRI machines typically cost between one and three million dollars.) Lacy later said that when he reviewed the images, “I was just completely floored. Never before in my life had I had such a strong feeling that I was looking at something that was really the future of an industry.” He felt “a tremendous peace of mind just not to worry about what was going on inside my skin.” He realized that others would pay to feel the same way.
Within a few years, Lacy and Attariwala had opened a clinic together in Silicon Valley. Some of the venture capitalists they screened became investors. Prenuvo ultimately raised more than seventy million dollars; its backers include the 23andMe co-founder Anne Wojcicki, the supermodel Cindy Crawford, and the former Google chairman Eric Schmidt. Prenuvo’s growth is, in part, a feat of marketing. The company has won the support of business leaders, celebrities, and influencers by crafting a narrative for the social-media era: these scans can catch the hidden health risks that might otherwise kill you. If you take a free “risk test” on Prenuvo’s Web site, the company sends a report guesstimating your risk of various conditions—but also persistently calls and e-mails you to try and sell you a scan. This year, at New York Fashion Week, Prenuvo arranged free scans for the designer Zac Posen, the model Lily Aldridge, and the editor Olivier Zahm, who completed his scan between runway shows. In August, Kim Kardashian posted a photo of herself in front of an MRI machine, wearing charcoal-gray Prenuvo scrubs, to hundreds of millions of followers on Instagram. “It has really saved some of my friends lives and I just wanted to share,” she wrote, adding the hashtag #NotAnAd. (Kardashian has previously used imaging to prove that her butt is real.)
Prenuvo now has nine locations, with plans to open a dozen more; some employers offer free MRI scans as staff perks. The company also has several competitors—most notably Ezra, a New York-based startup that has raised more than twenty-two million dollars. Ezra offers full-body MRIs at prices ranging from a thousand three hundred and fifty dollars to twenty-five hundred dollars, and five-year memberships for seven thousand. The company recently received F.D.A. approval for an A.I.-assisted technology that generates data from quicker and less detailed scans; eventually, it hopes to offer fifteen-minute MRIs for five hundred dollars. The founder of Ezra, Emi Gal, often tells stories about patients who have died of conditions that might have shown up on a scan. He told me that his mother died of cancer around the time he founded the company, and he often wishes she were screened earlier. “People should get scanned at least once a year,” he said.
When I asked Gal about the lack of scientific evidence for such a claim, he told me that “state-of-the-art technology is always ahead of the guidelines.” He seemed to be suggesting that some future study will inevitably validate his company’s technology, proving the experts wrong. Modern mammograms were developed in the nineteen-sixties, he pointed out, but it took more than a decade for the American Cancer Society to recommend them as a screening tool, and uniform standards didn’t exist until 1992. (Some doctors now argue that mammograms are overused; one large study found that decades of screening did not reduce breast-cancer death rates, and that one in five diagnosed breast cancers may have been unnecessarily treated with chemotherapy, surgery, or radiation, as they might not have harmed the patient.) “If you go to an epidemiologist and ask, ‘Should we be screening thirty-year-olds for cancer?,’ they will say, ‘No way,’ ” Gal has said. “But what if you’re the thirty-year-old who happened to have a headache that turned out to be brain cancer?”
In a 2004 episode of the sitcom “Scrubs,” Bob Kelso, the chief of medicine at Sacred Heart Hospital, runs into a fellow-doctor, Perry Cox, in the hallway. “I am considering offering full-body scans here at Sacred Heart,” Kelso says. “What do you think?”
VIDEO FROM THE NEW YORKER
Nauha: A Caretaker’s Saintly Patience
Cox looks appalled. “I think showing perfectly healthy people every harmless imperfection in their body, just to scare them into taking invasive and often pointless tests, is an unholy sin,” he says.
“Does sound a little sketchy ethically, doesn’t it?” Kelso says. “Thanks, Perry.”
Later, Cox meets a friend at a bar and brags about how seriously his boss seems to have taken his advice. Then he glances up at a television and sees a commercial in which a mother consoles her young daughter.
“Mommy, when’s Daddy coming home?” the girl asks.
“He isn’t,” the mother responds tearfully, pulling the girl to her chest. “If only he’d loved us enough to get a full-body scan at Sacred Heart.”
A message flashes at the bottom of the screen: “call now!”
“Scrubs” was making fun of a real industry’s boom and bust. In 2000, demand for head-to-toe CT scans—essentially, three-dimensional X-rays—surged after “The Oprah Winfrey Show” featured a Newport Beach doctor who offered them to the general public, without a physician’s referral. The scans weren’t covered by insurance and cost about a thousand dollars each. Whoopi Goldberg called them “the most comprehensive health exam that exists”; William Shatner said, “I’m sending everyone I know.” Similar businesses popped up around the country: CT Screening International, AmeriScan, ScanQuest. One company outfitted vans with scanners and drove them around small towns in the American South. Medical societies, however, warned that the scans had high rates of false positives; they also delivered enough radiation to increase the risk of some cancers that they aimed to detect. Before government-funded studies could properly evaluate the scans’ effectiveness, most of the companies offering them collapsed.
Full-body MRI scans are different from CT scans in two key ways: they don’t subject people to potentially harmful radiation, and they are better at surveying the soft tissue of our internal organs, where cancers commonly arise. The other complaints, however, still seem to apply. MRIs are sensitive enough to pick up subtle abnormalities that can be clarified only with further tests, and sometimes those tests cause harm: pain, radiation, infections, financial and psychological distress. Their growing popularity suggests...
thyroid cancer never rose, and remained very rare. Diagnosing these cancers wasn’t saving lives: almost all were papillary thyroid tumors, which are present in as many as a third of all adults and rarely cause problems. Nonetheless, tens of thousands of South Koreans had their thyroids removed and started taking lifelong hormone supplements. They’d fenced in turtles.
When doctors screen healthy people with highly sensitive tests like MRIs, they tend to turn up a barrage of ambiguous findings. Is that an aneurysm waiting to burst, or a harmless vascular variant? Is that a deadly cancer, or just a blob of fibrous tissue? “You pick up some incidental finding and get put on the surveillance train,” Saurabh Jha, a radiologist at the University of Pennsylvania, told me. “And sometimes that train derails.” I’ve seen this happen. I send off a patient to be scanned for a blood clot, which inadvertently reveals an abnormality in the lung. It’s probably nothing, but, just in case, I schedule the patient for a biopsy, meaning that someone will have to cut into him and slice off a bit of lung. The biopsy causes an infection, which requires antibiotics, which causes diarrhea; a hospitalization and lengthy rehabilitation follow. The biopsy is negative. “It’s like a Greek tragedy,” Jha said. “Once you have the information, you can’t unsee it. You are compelled to act.”
Ishani Ganguli, an assistant professor of medicine at Harvard who’s conducted foundational research on such “cascades of care,” said that patients may start to see themselves as unwell by default. One of her patients incidentally learned that they had developed a small aneurysm. The aneurysm is “probably never going to affect them medically, but it’s completely changed the way they experience symptoms,” Ganguli said. “Now, every time they have a headache, they seek urgent care.”
On top of all that, there’s the cost—not only to the individual, but to the system. Follow-up testing to clarify ambiguous findings is often covered by insurance, meaning that in the end, we all share its costs. Ganguli studied patients who received a routine electrocardiogram before a low-risk cataract surgery. As many as one in six experienced a care cascade that often included ultrasounds, stress tests, and visits to a cardiologist, adding up to an estimated thirty-five million dollars in extra medical spending nationally each year. These follow-ups don’t appear to help most people, Ganguli said. The only thing stopping full-body MRIs from triggering an even larger wave of spending, she added, is that the typical patient can’t afford the scans, and they haven’t been proved to be beneficial; as a result, they remain relatively niche. “The reality is that they’re unlikely to be covered by insurance, because there is no study showing that full-body MRIs have net benefit,” she said.
Compared with stories about deadly tumors hiding in our bodies, conversations about scientific studies and insurance coverage can seem bloodless. In this respect, Ezra and Prenuvo have a clear narrative advantage. “If I was a layperson, I would find this incredibly bewildering,” Matthew Davenport, a radiologist who co-directs a cancer center at the University of Michigan, told me. “Like, why can’t you just use this technique to find cancer? My empathy for that view is high—but, unfortunately, the common sense is wrong.” Davenport guesses that the average person would benefit from a full-body MRI less than 0.1 per cent of the time—whereas “you have something happen to you that is expensive, annoying, psychologically harmful, or physically harmful maybe five or ten per cent of the time.” He went on, “You’re searching for a needle in the haystack—only the haystack causes harm.”
In September, I set out to receive my own Prenuvo scan. On the company’s Web site, I clicked past a stock photo of a cheerful woman and child and discovered that zero appointments were available for several months. According to the Wall Street Journal, wealthy New Yorkers, returning from summers in the Hamptons, were to blame. I took to checking for openings several times a day. One evening, after putting my kids to bed, I saw one and felt a rush of excitement—but, by the time I clicked, it was gone. I felt like a Taylor Swift fan trying to buy sold-out concert tickets.
Next, I called Prenuvo’s customer line in the hope of sweet-talking someone. A representative named Ben asked, “Hey there, how can I help you?”
Ben had a low-key confidence that I associate with lacrosse players. “Hold on a sec,” he said. “Our system is kind of bugging out right now.”
After a few minutes, he returned with bad news. “Sorry, bro,” he said. “There’s nothing until the week of Christmas.”
“It didn’t used to be this hard to get a scan,” he went on. “We kind of blew up recently.” He texted me his direct line.
A few days later, on the subway home, I checked my phone, and saw a new opening. I rushed up to my apartment so I could spend eighteen hundred dollars on a head-and-torso scan. Prenuvo made me feel like I’d won something—the chance to see inside my own body. At the same time, I felt guilty. I was trained in evidence-based medicine, and the evidence suggested that I was wasting resources. The night before the scan, my guilt turned to anxiety. Was I about to learn something that I didn’t want to know?
When the day came, I took the subway to Penn Station and found Prenuvo’s office next door to a Five Guys. The building was splashed with testimonials. “Prenuvo gave me the peace of mind I deserve,” declared a partner at an investment firm.
The waiting room was heavily perfumed, with soaring wood ceilings that reminded me of upscale hotels. As I helped myself to a free seltzer, a shelf full of health books caught my eye. One was dubiously titled “Super Human: The Bulletproof Plan to Age Backward and Maybe Even Live Forever.”
After I donned Prenuvo scrubs, a bearded technician named Zach led me to a large room that housed the MRI machine. It looked like a giant white doughnut.
“Seems like it’s been busy,” I said nervously.
“After Kim Kardashian posted on Instagram, we got, like, a hundred thousand more followers in a week,” Zach said. “It was nuts.”
Zach eased me onto a padded table. He lowered a shield over my chest and covered my head with a helmet. For a moment, panic and claustrophobia swelled within me. I was about to spend an hour like this.
“Try some deep breaths,” Zach said soothingly. Then he placed headphones over my ears and a mirror in front of my eyes, so that I could watch a television behind me. As the table rolled into the scanner, Taylor Swift started playing. I’d finally made it to my concert.
Most of the people I spoke with for this story told me that they were happy they got a preventive MRI. Some expressed a sense of relief in discovering that a nagging pain wasn’t anything serious. A young woman who received an ambiguous finding, which later turned out to be benign, told me, “It was absolutely worth knowing about. The scan gave me a sense of control.” Almost everyone said that they’d recommend the scan to others. “The medical...
You’ve read your last free article. Subscribe now. If you're already a subscriber sign in.
More Science and Technology
Can we stop runaway A.I.?
Saving the climate will depend on blue-collar workers. Can we train enough of them before time runs out?
There are ways of controlling A.I.—but first we need to stop mythologizing it.
A security camera for the entire planet.
What’s the point of reading writing by humans?
A heat shield for the most important ice on Earth.
The climate solutions we can’t live without.
Sign up for our daily newsletter to receive the best stories from The New Yorker.
Dhruv Khullar, a contributing writer at The New Yorker, is a practicing physician at Weill Cornell Medicine and an assistant professor at Weill Cornell Medical College.
More:
Medicine
MRI
Cancer
Read More
The Legend of the Selmer Mark VI
The Weekend Essay
The Legend of the Selmer Mark VI
A horn that hasn’t been made for decades dominates the imaginations of saxophone players, including me. What magic, if any, does it hold?
By Chris Almeida
Will a Full-Body MRI Scan Help You or Hurt You?
Companies like Prenuvo and Ezra will use magnetic resonance imaging to reveal what’s inside you—for a price.
Illustration by Jack Sachs
Ryan Crownholm, a middle-aged Army veteran with luminous green eyes and a strong jawline, likes to describe himself as a health hacker. He has written on LinkedIn that, after founding and running several construction-related companies, he started to think of his own body as a data source. During the pandemic, he attached a continuous glucose monitor to his skin, bought an Oura ring to monitor his sleep, and signed up for a healthy meal-delivery service. “I started tracking each of my data points,” he wrote. “I outsourced my diet.” Every few months, a pricey concierge doctor—“kind of my longevity guy,” he told me—sends his blood for comprehensive testing. To assess his bone health and body-fat composition, Crownholm gets regular dual-energy X-ray absorptiometry, or dexa, scans, which are normally recommended for older women at risk of osteoporosis. “Quantifying everything allowed me to be successful in business,” he told me. “I think it’s the same with health.”
More Science and Technology
Can we stop runaway A.I.?
Saving the climate will depend on blue-collar workers. Can we train enough of them before time runs out?
There are ways of controlling A.I.—but first we need to stop mythologizing it.
A security camera for the entire planet.
What’s the point of reading writing by humans?
A heat shield for the most important ice on Earth.
The climate solutions we can’t live without.
Dhruv Khullar, a contributing writer at The New Yorker, is a practicing physician at Weill Cornell Medicine and an assistant professor at Weill Cornell Medical College.
No comments:
Post a Comment