Is it worth having a full body MRI scan?

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.