(Updated Feb. 2024) The whole-body “preventive” scan comes up every so once in a while: People, saying they want to take control of their health, put substantial sums of money into a full-body MRI or other test that is not ordered by a doctor, but instead at their own will. The idea is that they’ll know their body better, and maybe find a small and imperceptible problem that is going to get big later, and thus get a jump on treatment.
Good or bad? Positive or negative? Healthy or no?
Most doctors say no. Some patient engagement people say yes. The people who are selling them say definitely yes. Who’s right — specifically about the “whole-body MRI scan” that’s being offered by several buzzy startups?
“These are a horrible scam that is vastly more likely to ‘find’ something harmless that has to be addressed now that it’s found than to actually do anything useful,” Al Lewis, CEO of Quizzify and founder of the Validation Institute, wrote in response to my question on an online group of healthcare experts. “Honestly you couldn’t pay me to get one.”
On the other hand, the owners and marketers claim to detect and avert cancer and other illnesses, along with the support of celebrities like Kardashians and people like the Silicon Valley extreme health advocates who are looking for the fountain of youth. (Of course it seems clear that someone’s making money on this, and in healthcare it always pays to follow the money — be it an influencer painting a rosy picture, or a scan company telling you how great its products are.)
What it’s all about
Among the best known are Ezra and Prenuvo. These companies are marketing their scans heavily, with influencers all over social media with positive reviews.
Ezra says “Screening is our best defense against cancer. And we’ve perfected it.” “Ezra has helped 13% of our members identify potential cancer early,” and “In just one hour, The Ezra Full Body looks for potential cancer and over 500 other conditions in up to 13 organs.” Pricing? Full body is $1,950; full body plus (including lungs) is $2,500. Full body “flash” is $1,350. They are also offering $200 off in January with the code JAN200. And they have a “couples plan” with discount for two. They also have multi-year plans. Ezra has raised $22 million, according to internet reports.
For Prenuvo, the sales pitch is “Put your health in your hands,” so you can “catch conditions before they become crises.”
Actress and model Cindy Crawford is a Prenuvo investor, with Google ex-Chairman Eric Schmidt and Anne Wojcicki, founder of 23andme.com. The company raised $70 million in 2022 in a funding round led by Felicis Ventures, NBC reported recently.
Separately, “launched by Spotify co-founder Daniel Ek, Neko Health raised $65 million this year, with backers including General Catalyst,” NBC added.
Another provider is SimonMed, a national chain.
What doctors and others say
But is this full-body scan a good idea, whether it’s a CT scan or an MRI?
Lewis added to his initial response: “OK, folks, I think it’s time for my annual review of the arithmetic of screening. This isn’t specific to full-body scans but the same concepts apply.
“Assume you are screening to find a 1-in-1000 abnormality. Which you pretty much are, with any screen other than the standard ones.
“Further assume that your screening technique is 90% accurate. Screen 1000 people and you will likely find the 1-in-a-1000…but you will also ‘find’ about 100 false positives that need more intensive followup.
“So the chances of a positive reading actually being true are about 1 in 100.
“Buyers’ failure to understand this arithmetic (and basic biostatistics) is what fueled the entire wellness industry, draining billions from employer and employee coffers and likely causing more harm than benefit, the Body-Shaming Hall of Fame.”
Another kind of story
Like Lewis, other members of the group of medically savvy professionals had a lot to say. Another member, Adam Rattner, a 41-year-old lawyer living in Connecticut, wrote: “I recently had a CT of my abdomen for stomach pains, that ended up being cancer in another area. I may be an anomaly, but that CT scan probably saved my life.”
His comment drew responses from the group. Lewis wrote: “Glad they found it! The difference there is that you weren’t screened. You were tested. A bright-line distinction between the two. Once is seeking sickness in the absence of any evidence. The other is responding to a symptom or other need.”
Rattner replied: “Great point. And even though it worked to my advantage, I think random full body testing is waste and abuse, without any clinical reasoning.”
‘Prey off of patients’ fears’
Replying to Lewis’s email, Dr. Mitchell Louis Judge Li, another group member, wrote: “I couldn’t agree more with Al Lewis. And of course, it’s another example of the unfettered corporate practice of medicine — when the practice of medicine (including diagnostics) are controlled by lay-corporations for profit, not physicians with a professional responsibility (and the requisite training and expertise) to put the interests of patients first. These scams prey off of patients’ fears while placing them at great risk for unnecessary expenses, anxiety, and physical harm.” Li is the founder of Take Medicine Back, a nonprofit advocating to reclaim the profession of medicine from corporate practice.
Dr. Cristin Dickerson, a diagnostic radiologist and CEO and founder of Green Imaging, wrote: “No good radiologist advocates for whole body CT but the new age wellness or ‘regenerative’ docs are advocating for and promoting full body MRI, equally as useless but less dangerous.”
Matthew Taber, a healthcare consultant who helps companies and individuals reduce costs, wrote of Dickerson’s remarks: “She is 1,000% correct. This is actually truly dangerous. My father is an academic MSK and emergency medicine radiologist and not a single one of his colleagues would ever recommend it. My academic evidence-based internist would not recommend it either.”
In a follow-up email, he wrote “Academic emergency medicine physicians will do a full body CT scan but ONLY under extremely strict academic evidence-based emergency medicine trauma protocols. Full body CT scans done by emergency medicine physicians on trauma patients are called traumagrams. While CT traumagram can rapidly identify problems in an emergent patient, CT traumagrams are mainly done to keep ambulance-chasing lawyers happy as well as attempt to keep physicians from getting in trouble with malpractice lawyers. The amount of radiation produced by a full body CT is only slightly less of the dose that Japanese survivors of Oppenheimer’s bomb were exposed to. That amount changes DNA and can cause cancer. This is why no ethical radiologist (or any ethical primary care physician) would ever recommend full body scan to be done as a preventative measure.”
Dr. Owen Scott Muir, author, TheFrontierPsychiatrists.com, wrote: “The incidental finding risk is not trivial. I recently had to send a patient for an evaluation by neurosurgery, which led to an inpatient admission, which led to a whole other series of scans, because of an incidental finding on a brain MRI obtained for a completely legitimate research purpose, But which revealed something that turned out to be nothing.
“The worry that it might be something led to a series of decisions that led an otherwise healthy person to get admitted for a neurosurgical work-up. That’s the kind of risk we’re talking about. It’s the risk that you’re going to spend weeks to months living in stark terror, And getting exposed to numerous other interventions and/or explorations, all of which have risk.
“Just say no to extra scans.”
‘Money-grabbing’
Dr. Nick van Terheyden, clinical specialist at Iodine Software, wrote that his 30,000-foot view is this: “Money-grabbing capitalization and slick marketing hung on the back of fearmongering. Cynically a means to keep selling the next innovation or supposed improvement in imaging technology that shows very limited benefit when compared to existing solutions especially when measured in benefit vs economic outlay.”
Are there any upsides? “”You *might* catch something so for the n of 1 it seems like a godsend. Some other good news here you only need to find a couple of these to have a veritable trove of misleading marketing material featuring these individuals who personally believe this is the best thing that ever happened to them and they can pontificate for hours on how lucky they are they used it and it saved them from near-certain demise. … (Cynically) it is also a great way to gather data for testing, commissioning devices and potentially even research.”
Downsides? “So, so many….For the other (much larger) x of people who find something and require follow-up or investigation plus all the associated worry. There is *always* some associated cost to the false negatives (excess costs, worry, and potential iatrogenic-induced side effects and sequela everything up to and including death) as well as the missed positives (oops, missed it, false sense of security leading to diminished sensitivity to clinically significant symptoms leading to later diagnosis). Even some well-established screening activities that are in regular widespread use are not straightforward wins — prostate and PSA, mammography, colonoscopy, and others.
“Adding to the already burgeoning medical debt
“Playing to the worried well and while not beneficial no doubt impacts the less fortunate who cannot afford these offerings.”
What should you do? “Don’t waste your money. Don’t be sucked in by marketing/advertising. Spend the money on exercise whatever that means for you as the single most economically valuable investment you can make in improving your health and longevity (IMHO) rather than wasting it on worrying about some fancy test you saw <insert name of some influencer people thing knows what the hell he is talking about here>”
Risks vs. benefits
Dr. Bill Besterman wrote: “There is a downside to whole body scans. Let’s just look at it from the perspective of CT scans of the chest. CT scans of the chest are used as screening tests to look for calcium in the heart arteries and cancer in smokers.
“Notice that I stipulate the CT scans are appropriate in smokers. It is all about risks vs benefits. When you do these scans, you see many small nodules that we called ‘incidentalomas.’ They were real changes in the scan. They demanded investigation. But they were almost all benign.
“This is a great example of ‘he who orders the test, deserves the result.’ I would not recommend that any health plan pay for whole body scans. The benefit vs the cost and risk is very small. I would not have one myself, and the greatest risk factor for cancer is age.” Besterman is a consultant and author of the Substack newsletter “Slow Aging and Delay Chronic Disease Development.” He is an internist who spent the last 25 years of his active practice doing preventive cardiology.
Who does support these scans?
In my circles, while reporting this piece, I could not find a single person who was enthusiastic about the kind of whole-body MRI or CT screening for people without symptoms — except for the influencers, the investors and the people inside of these companies, who make money when you decide to get a whole-body scan. This made me wonder who is actually supporting this besides Kim Kardashian and the investors?
The billionaire investor Mark Cuban caused a firestorm in 2015 by going on the record publicly in support of this kind of screening, in his case advocating blood tests on a quarterly basis, in the absence of any symptoms. He later helped a biomagnetic imaging startup raise money for cardiac scans. It does seem to be true that while many medical professionals think this kind of scan for no apparent reason has no value, it has found resonance with the “worried well” and people who are interested in cheating death like the current Silicon Valley contingent of super-exercisers with heavy supplement diets and plans to live forever.
Doctors told Cuban he was wrong, and people schooled him on social media — including a number of experts explaining why this is a bad idea: more health care does not mean better health care, and asymptomatic testing for testing’s sake risks excess care and bad outcomes. (For the record, Mark Cuban Cost Plus Drugs, another of Cuban’s babies, is making major change happen in healthcare by offering generic medications inexpensively, often at a fraction of the price with insurance. We have written about this here and here and here.)
‘Latest technology’
This is not a completely new phenomenon: Places like the Princeton Longevity Center have been doing full-body CT scans for some time now.
“Get peace of mind,” the Princeton center site says. “Fortunately, most scans show that the internal organs all appear to be normal. Your Full Body Scan can bring you the peace of mind of knowing that you have used the latest technology to look for the cancers, plaque, aneurysms, stones, cysts and other abnormalities that other tests frequently miss.”
The Princeton center also offers various men’s and women’s health screenings, “Neuropsychometric Evaluation,” “Multi-Cancer Genetic Early Detection Testing” and “Low Intensity ACOUSTICWAVE Therapy for Erectile Performance.”
Elitra Health, calling itself “The Manhattan Center for Life and Longevity,” says it has “the premier executive health center on the East Coast,” with “world class physical examination center” and “incomparable luxury.” It also promises a full-body CT scan, along with a “digital X-ray” and “brain MRI,” along with other screenings.
A waste of money and resources
A recent New Yorker article by Druv Khullar takes apart the idea of the whole-body MRI: “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. ”
Khullar writes: “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.’ “
He also refers to the industry’s boom-and-bust cycle: “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.
“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.”
Khullar had his own full-body scan, which, predictably, found a spot on his prostate. The cascade of care then followed: “The immediate cascade would probably cost several thousand dollars, split between me and my insurance. I thought about the other ways in which the money could be spent: months of insulin for diabetic patients; scores of inhalers for asthmatic children; colonoscopies that are proven to find cancer and save lives.”
One of his doctors said: “Prenuvo probably views your story as a success — I view your story as a tragedy. They’ve created in your mind this uncertainty. You were a healthy person, and now you’ve become a patient.”
‘You may already be dying’
Undark Magazine wrote about this theme a while ago in relation to a brain quiz offered by the Northshore University Health System: “There is a memorable episode in the now-classic sitcom Scrubs in which the conniving Dr. Kelso unveils a plan to peddle useless ‘full body scans’ as a new revenue stream for the perpetually cash-strapped Sacred Heart Hospital. The irascible but ultimately patient-protecting Dr. Cox objects loudly. ‘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. Undeterred, Kelso launches an advertising campaign that promotes the scans in a tear-jerking television commercial and a billboard screaming ‘YOU may already be DYING.’ “
This kind of remote testing of your health also extends to things like Tally Health, which wants to charge you a monthly membership from $130 to $200 to tell your biological age. One reporter, Anna Medaris, wrote “I’m 36 and often get told I look younger, but a ‘biological age’ test said I’m almost 42,” so — draw your own conclusions about the value.
One scanning organization, Superior Body Scan, in California, offers a $425 body scan, $799 for two people; they upsell to a $799 body scan and virtual colonoscopy, with $1,499 for two.
His and hers colonoscopies — just in time for Valentine’s Day.
