Would you get a whole-body MRI scan to check for cancer and other problems even if you don’t feel any symptoms? Some have done just that and saved their lives. Others simply find out that they’re relatively healthy.
According to Prenuvo, one of the companies doing preventative MRIs, it can detect up to 500 different conditions, problems, and cancers in your body. And while some people have had their lives saved, some doctors say this is unnecessary, or even harmful.
I seem to fall somewhere in the middle.
I recently did a 60-minute full-body MRI scan. I learned I’m mostly healthy, but there are some potential problems. The CEO and co-founder of the company that ran the MRI says that adopting these kinds of scans would be part of a switch from sick care to health care, and it could save both millions of lives as well as billions of dollars.
We chat about the technology, how it works, what it can do, and what it can’t do. We also talk about why doctors are in general skeptical … and why my doctor specifically didn’t take the results super-seriously.
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Full transcript: chatting with Prenuvo co-founder and CEO Andrew Lacy
John Koetsier:
Would you get a whole body MRI scan to check for cancer or other problems even if you don’t have any symptoms?
Hello and welcome to TechFirst. My name is John Koetsier.
I recently spent an hour getting scanned in an MRI machine. It’s super noisy, I had no idea. It’s actually also super uncomfortable for long periods. I don’t think they were designed for an hour, maybe 10, 15 minutes, but it gives you images of your body that you’ve never seen before and your doctors probably haven’t either.
Also, according to Prenuvo, one of the companies doing preventative MRIs, it can detect up to 500 different conditions, problems, and cancers in your body. Some people have had their lives saved by finding something, and some doctors say it’s actually unnecessary or even harmful.
Here to chat is the founder and CEO of Prenuvo, Andrew Lacey. Welcome, Andrew.
Andrew Lacy:
Thank you. It’s great to be here, John.
John Koetsier:
Hey, super happy to have you. Talk about a full body MRI. Why do it?
Andrew Lacy:
Well, I think the starting point here is to say that we obviously have a health system that’s very reactive. And in fact, it’s, I think, a $4.7 trillion part of our economy right now. So it’s the largest part of the economy. And about 95 or 96% of that is actually spent on reactive healthcare.
And so particularly coming out of the pandemic, I think there’s been just such an awareness of the importance of getting ahead of health problems. And Prenuvo provides its patients with a way to really look underneath the skin and see what’s going on and identify not only things that could kill you earlier than you would like, things like cancer and aneurysms, but also to really start to understand how the way we’re living our lives is impacting our underlying physiology.
And that’s really exciting because… that’s often so early that you don’t even need to access the medical system, you just make lifestyle changes. And you know, not only can you live longer, but you can live much healthier.
John Koetsier:
I love how you put that, could kill you sooner than you want to. Most people would say anytime it’s going to kill me, it’s sooner than I want to, but that’s all good.
I seem to detect in your accent a hint of Australia, am I correct?
Andrew Lacy:
That’s correct. I grew up in Melbourne, Australia and moved over to the US in 2003 to do an MBA in the San Francisco Bay Area and then sort of fell in love with entrepreneurship. And I’ve been doing that now for the last 15 years.
John Koetsier:
Excellent. So we’ll get into more specifics about the MRI itself, what it finds, what it doesn’t find, all that stuff and how it fits into healthcare systems.
But some doctors aren’t fans. Why is that the case?
Andrew Lacy:
Well, I wouldn’t say that they aren’t fans about what Prenuvo is doing. I would say that they aren’t fans of screening asymptomatic patients in general. And a large part of that is rooted in the way that this has historically been done.
So about 20, 25 years ago, there were actually a couple of companies that put CT machines in shopping centers and people could actually get screenings for cancer. And the problem with CT is it involves radiation. So you use it enough and you may well find cancer, but you also may well have sort of put it there.
And it’s also not very accurate for a lot of other conditions that you could see in the body. So what ended up happening was, you know, there were a lot of findings, indeterminate findings. We see something here, we see something there, you should go and do more tests to figure out what that is.
And that’s largely fallen out of favor, but it definitely poisoned the impression that a lot of physicians had of screening in general.
Now, so go forward 20, 25 years, the technology that we use at Prenuvo is MRI, so it doesn’t involve radiation. And you mentioned the scan took some time. Well, it takes a little bit of time just because every image that we take is clinical diagnostic quality. And that’s one of the things that’s quite different. And we’re only able to do this in the last few years because of advances in hardware and software. And… a lot of physicians are just not up to date on these changes, understandably. And so, you know, part of our, a very big part of our role is educating physicians on how this technology has changed and how the results that you get from these screenings are quite different to what they had seen in the past.
John Koetsier:
So maybe talk about what it can detect.
What can you find in an MRI scan?
Andrew Lacy:
Sure, so how it works is we are imaging the body at a number of different tissue weights. So we’re actually able to take photos inside the body and filter for different types of tissue. So we can filter for fat, we can filter for muscle, we filter for fluid, we filter for blood.
And one sequence in particular, which we are one of the, if not the world’s leaders on, is a sequence that actually filters for hardness. It’s a sequence called diffusion.
And why is it really, why is filtering for hardness sort of very interesting in the body? Well, you might recall that women are told to feel their breasts for lumps. And the reason why that is a great preventative health technique is not because every lump is gonna end up being cancer, but because all solid tumors are for the most part, harder than the surrounding tissue.
And of course, you can feel your breasts but well, for obvious reasons, but it’s very, very difficult to feel your lungs or your pancreas or your kidneys or other parts of your body. And so with the MRI, we’re able to do that digitally at much greater precision.
And so we take all these images of your body and we’re able to then layer them on top of each other, sort of like Instagram filters and look at any one three-dimensional pixel in your body. We call them voxels. And depending on how it appears on these different image sequences, we can be quite precise about what we’re looking at.
And so, whereas historically, for example, with CT screening, you might see something like a lesion in the liver, but not know what it is … we would see that same lesion, but we would be able to identify it as containing fluid, in which case, for example, it might just be benign cyst or containing fresh blood, in which case it’s most likely sort of internal birthmark. It’s called a hemangioma. And so because of all these filters, we’re able to be a lot more accurate for most everything that we see. MRI is fantastic at evaluating soft tissue. So that means that, you know, and by soft tissue, it’s a radiology term for our organs. And that’s where most of the problems are that we face as we age.
And so outside of cancer, most everything we can see physiologically with MRI, we’re able to diagnose with one of these exams. So it’s really interesting. And I think probably the biggest insight we’ve had having done this now for 10 years is just how early we can actually see some of these conditions.
And because we can see them very early, that means the window of detection is quite large. And it’s sort of this very beautiful side effect of the way our bodies work. They have such built-in redundancy that we can actually do a decent amount of damage before we start feeling any symptoms. And that damage is there, we can see it, we can oftentimes quantify it, we can diagnose it, and we can do that many times, you know, 10, 15 years before. that damage reaches a point where the plasticity in the body sort of gives up and the organ starts going into a sort of advanced sort of failure mode.
And that’s what’s so exciting about imaging patients and be able to give them these insights so early. They can really make a difference in their sort of health outcomes. So, I think that’s a really good point.
John Koetsier:
Super, super interesting. Are there any false positives? Is there any reason that you might find something that doesn’t exist?
Any challenges there?
Andrew Lacy:
Well, I think every imaging modality, in fact, every test has some level of false positives. So, you know, mammogram, for example, I believe the false positive rate is something like 50%. So they find something that they want to biopsy, there’s only a 50% chance that it may in fact be cancer. So existing tests that are covered by the health system actually have reasonably high false positives.
Lung cancer screening is another example with CT, little tiny nodules that end up being granulomas, not lung cancer, but they follow them, you know, for several, several months afterwards to see if they change over time. So there are false positives in the medical system.
We for sure have some, but we don’t share all of the findings that we make, we risk stratify.
What I mean by this is we don’t often diagnose cancer, for example, we diagnose something that is highly suspicious of malignancy or something that at the other end of the spectrum is benign and you should do nothing about. And we together with other folks around the world have pioneered a new classification system for lesions in the body called ONCO-RADS. And that enables us to actually sort of grade everything that we see. And with one and two being benign and four and five being increasingly problematic and three in the middle being sort of we’re not certain and our goal really as a company is to reduce as much as possible that third category because that’s the one that causes the most obviously concern for physicians.
One of the good things is because most lesions that end up in that category tend to be quite small and therefore hard to characterize, oftentimes the only real follow-up that’s required is to do another one of these exams after a year or so and just make sure that whatever was there is stable.
John Koetsier:
So … super interesting because I did it. And I got back a report. It’s literally a 16-page PDF report. Apparently I’m pretty healthy, so that’s good news.
Andrew Lacy:
Congratulations.
John Koetsier:
And the radiologist, the radiologist who talked to me said, this is actually really good, really amazing, but there was one area of concern. And that is there’s some multifocal marrow signal abnormality somewhere in my pelvis.
And so there’s something and they suggest, check it out with a specialist CT scan: that’s recommended.
So I brought it to my doctor and my doctor looks at it and he says, and he’s like: do you have any symptoms? And I’m like, do I have any symptoms? I mean, like I just ran down a mountain. I’m in the gym four days a week and I walk a lot and I do a lot of hiking. You know, I’m always sore somewhere … how would I differentiate? I don’t know.
And so anyways, he’s sending me for some blood work to see if there’s something that he can find there, but he’s leery about sending me for the scan that’s recommended. And, and I’m like, well, there could be something here. He says, well, there could not be anything there. And, and, you know, or most of what maybe what it found isn’t a big deal.
How do you deal with that situation?
So I’m in Canada, it’s a social healthcare system. In the States, I suppose you can just order whatever scans you want, but maybe your insurance won’t cover it. How do you deal with that?
Andrew Lacy:
Yeah, it’s a constant process of educating physicians. I think it involves a little bit in some ways like changing the script as a physician. If we find something in a patient that is concerning to us and I’m not saying this, not knowing your findings, I’m not speaking in generality here. Oftentimes, you know, it sort of changes the risk profile of the individual.
But physicians, especially in social medicine systems, sometimes are making sort of statistical based choices that apply to the entire population.
So a simple example, and this happens a lot with women in particular and ovarian cancer, and this is part of the reason why ovarian cancer is called so late, is the symptoms of ovarian cancer are abdominal pain. not life-threatening. It could be an inflammatory condition because you may be gluten intolerant or something like this. And it takes a really long time to walk through all of the much more likely and less scary outcomes.
And that’s why in all medical systems, it takes just so long to diagnose a condition, even from the point of their being symptoms, it takes six months on average for those symptoms become more and more specific over time and more and more indeterminate sort of earlier or asymptomatic and the health center just doesn’t know how to deal with those because their decision tree starts with symptoms.
And, you know, and so that’s really hard as sort of a hard thing to actually do then, well, how do I figure out the sort of Bayesian probabilities now when, you know, everything I learned in medical school starts with a symptom, you know, requires two or three, you have this and this and this, then this is the sort of like next course of action. It’s a really difficult challenge.
And to be honest, it’s something that we spend a lot of time talking to physicians about. We’re doing a lot of research ourselves to help just really understand and quantify the impact that these screens have had to patients that we have performed them on. But fundamentally, you know, that’s part of why we want: our customer is in some ways the patient, not the doctor, or the patient and the doctor. And the idea is for you to be as informed about your health as a physician might be, so that then you can go out and access the health system, hopefully with information that enables you to really take control.
Unfortunately, I cannot solve the Canadian health care system on this podcast.
John Koetsier:
No one has been able to figure it out yet.
You’ve talked about healthcare versus sick care and a transition in thinking, and you just mentioned it. Everything starts with a symptom. Well, what if you’re asymptomatic? Or what if, you know, there’s something, I know there’s been cases. where people, I believe it was a 2019 TED conference in Vancouver came in and 60 people got scanned at your facility in Vancouver, BC, Canada …
And one woman found something and she, it was, I forget the details … but her sister literally had the same condition and died from it. A couple months later or a month later or something like, she got it dealt with and she was healthy and fine. She had no symptoms, she had no reason to suspect anything was wrong, but this potentially saved her life.
Andrew Lacy:
Yeah, it happens all the time.
And in some ways, the way we live our life can obviously control our risk of, it affects our risk of whether something is gonna happen to us, but no one has no risk. And so there’s always that possibility that we find something potentially life-saving in someone.
And to be honest, what’s really, really exciting is a lot of people focus on cancer, the overwhelming majority of cancers that we find at stage one. And it’s led us to believe – and there’s some research out of Hopkins and other institutions about this – that cancer actually spends three or four years at stage one and so there’s just such a tremendous opportunity to diagnose these conditions so early that you can really affect health outcomes in a positive way.
And if you start to do them at a population level then you can not only save lives but also potentially save tremendous costs from the system. One example would be, we have an abbreviated scan, so that 10-15 minutes that you were looking for when you went in the machine, we actually do have a 15-minute scan that just looks for cancer in the torso.
To do that scan at population level in the U.S. with every adult every two years probably would cost about $60 billion. Now it’s a lot of money. But we spend in the U.S. about $130 billion just on late stage cancer drugs.
So there’s a real possibility that approaches like what we are pioneering could fundamentally transform the health system over time. And we might look back on sort of the way we’re doing health today in 20 or 30 years and just sort of shake our heads and consider just how crazy it was that we actually didn’t, that we waited until things were advanced before we did anything.
John Koetsier:
The thing that comes to mind was during the height of the COVID pandemic or maybe even early periods and a certain billionaire former president of the United States would say, hey, you test more, you find more.
I think that’s one of the things that maybe healthcare systems are worried about.
But you basically answered a question I was going to ask you. Do you save money? if you find cancer earlier? Like, I’m not even talking about healthcare outcomes in terms of saving lives, which is the primary thing and the thing that most people care most about, but does a healthcare system save money if they detect cancer earlier or other conditions and treat them early?
Andrew Lacy:
Well, let me answer that question in two ways. As an individual, I worked at McKinsey well before I got into entrepreneurship. So I was a bit of a whiz on Excel. And so before I started to invest my own time in this, I really wanna understand the answer to that question. And so we put together a big model and we were just looking at the top 15 cancers, I believe and we looked at the average stage of detection versus getting it detected at stage one and what would be the impact on outcomes on medical costs on productivity loss on the cost of lives lost.
And the end result was if you valued a year of your life at an additional year of your life at something like $20,000. Then doing one of these scans would be break even for you. Doing one of these scans every year at the cost of this, which is $2,500. So as far as the individual concerned, I would say most people would say, a year of my life is worth more than $20,000.
So from the individual point of view, that sort of calculation makes sense.
When you move to the population or to health programs, the calculation is a little bit different because they don’t always necessarily value the cost of a life saved. And unfortunately some cancers are caught, some cancers are caught quite later, actually quite inexpensive to treat because unfortunately people pass away really fast.
So, it’s a much more complicated question and I think that means as a company, our focus really is twofold. One is how do we scale up what we’re doing so that the cost of providing the screenings comes down to a point where it is much more accessible to more people.
And our goal as a business is to bring that $2,500 scan down to $500 over time.
Secondly, as the cost of the scan comes down, it becomes obviously not only easier for individuals to afford it, but it becomes more likely that it would also be adopted by the health system as part of standard of care. And we’re working to… sort of make that happen and those are long conversations, but we hope that eventually this will be something that will be available to everyone.
John Koetsier:
What’s interesting to me and what you just said is that in a for-profit healthcare system like the US, there may not be a lot of incentive to detect early and treat cheaply because you may make more money, and I’m sure doctors don’t do this, but I’m sure some others in the system do do this.
You probably make more money by detecting a little later and treating over a longer period of time with more aggressive treatments and surgeries and drugs and everything like that.
But in a socialized healthcare system, which let’s be honest is most of the world, right? You’ve got Canada, but you’ve also got all of Europe. You’ve got Asia, you’ve got many other places that have a social safety net of healthcare services. It’s essentially taxpayer money and it’s government money that is funding most of healthcare. That can lead to a wider purview. What is the cost of losing this worker? What is the cost of losing this taxpayer? What is the cost of losing this person? And so you can look at it from a broader perspective.
That’s interesting and that’s something that I’ll probably wanna dig into.
I had an additional question on the imaging that comes out of this. You mentioned it was 3D and everything like that. How do you see that? How do you get that? So I got a 16 page report. I’ve got these 2D black and white images. Can a doctor go in and in some VR or in some other way see sort of a 3D perspective of what the particular issue that might be found looks like?
Andrew Lacy:
We’ve actually loaded the images up in VR. It’s great eye candy. It’s not particularly useful for diagnosing patients. It’s actually a lot less efficient at this point in time. So when we take images of your body, we take images in called slices. So we actually are slicing you up in two dimensional slices, and then we sort of layer them on top of the other.
John Koetsier:
That’s pleasant.
Andrew Lacy:
Yeah, it’s sort of an interesting mental image. But yes, we slice you up and then we lay them on top of each other. And, we’ve built our own special viewing platform just to view these 3D images efficiently, because most imaging exams that you would get in the health system typically only just look at one part of the body.
So look at a shoulder or a knee or a brain. And the software is really purpose built just for single body parts.
Because we take the entire body, we’re capturing over a billion data points. there are orders of magnitude more images, we’ve built our own viewing tools just to be efficient around the radiology that’s required to put together that 16 page report. It also brings into play, obviously, a potential role for AI, because once you move from two dimensions to three dimensions, there are certain things that, for sure, AI can do better than radiologists.
For example, measuring the volume of a three-dimensional organ is very, very difficult and can only really be approximated by a radiologist, but an AI can do that relatively easily. And why do we care about the volume of organs? Well, seeing how organ volume changes over time is actually a really great early indicator of an underlying disease process. And obviously this is most common in the context of the brain and how that might shrink over time and how is our individual brain shrinking relative to the average?
We all shrink, unfortunately, as we get older.
But also other conditions, we’ve diagnosed viral infections of spleen just by seeing a spleen go from a certain size to almost twice that size between one scan to the next. So volume really helps us understand a lot better what’s going on in the body. And that’s an example of an area where AI can really help speed up the process and obviously make the clinical insights even more helpful.
John Koetsier:
My father died of what they labeled as mylodysplasia, which is a sort of a cancer in bone marrow, actually. And one of the symptoms was massive hypertrophy of the organs, including liver and other things like that as well. And so it was, I can see how that would be helpful and very, very useful.
And I hope that… you do manage to scale and get to the $500 a scan mark, which isn’t cheap, isn’t pocket money for most people, but is certainly within the realm of accessibility. And I also hope that we do transition our healthcare systems to something that doesn’t require as much pain and lack of health before treating something.
Anyways, this has been a pleasure. Thank you for taking the time!
Andrew Lacy:
No worries, it’s great to be here. Thanks, John.
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