How I Built This with Guy Raz - Full body preventive health care with Andrew Lacy of Prenuvo

Episode Date: December 7, 2023

Andrew Lacy is the co-founder and CEO of Prenuvo, a company offering full body scans that have the potential to detect disease early and before symptoms. When Andrew was introduced to radiologist Rajpaul Attariwala, he had already built and sold two tech companies. So after stepping out of Attariwala’s MRI machine, Andrew saw the same opportunity he’d seen years earlier in the iPhone… This week on How I Built This Lab, how Prenuvo is working to change the health care industry one scan at a time. Plus, Andrew responds to medical establishment criticism and outlines the problems in health care that Prenuvo helps solve.  This episode was produced by J.C. Howard with music by Ramtin Arablouei. It was edited by John Isabella with research help from Alex Cheng. Our audio engineer was Neal Rauch. You can follow HIBT on Twitter & Instagram, and email us at [e-mail] Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

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made it feel less like a visit and more like we were actually living there. Plus, taking a trip is the perfect time to host your space on Airbnb. your place with all of its personal touches and its amazing location could make someone else's vacation even better. Your home might be worth more than you think. Find out how much at Airbnb.ca.com slash host. Hello and welcome to how I built this lab. I'm Guy Raz. So most of the time you go and see a doctor when you have a symptom, right? A cough, an ache, a fever, and usually you get treated for that symptom. But over the past few years, the concept of preventative medicine has really started to reshape how medical care is administered. Preventative health care is now a $250 billion industry and growing. The idea, of course, is to identify potential problems before they blow up into something

bigger. Now, a few years ago, if you wanted to get a comprehensive blood test or an MRI, it had to be ordered by a doctor. But today, several startups, are offering these services. And right now, the fees are high, but over time, they're likely to decrease. One of these startups is called Pernuvo. They offer full-body scans using MRI machines, and these scans can reveal a lot of information about your health. The service Prenuvo offers is a little controversial in the medical community because many doctors believe these scans aren't necessary for most people. But despite the pushback, Pernuvo is thriving. They've built built MRI centers in cities across the U.S. with plans to expand even more.

The company was co-founded by Andrew Lacey. He's a serial entrepreneur who grew up in Australia. Earlier in his career, Andrew launched an iPhone app that got acquired. He then started a search engine for travel recommendations, and eventually he came upon an idea that would turn into pre-newvo. I did what a lot of entrepreneurs do, which is I sat down and thought what I was passionate about. And I realized that there are a lot of things I'm passionate about that don't necessarily make great businesses. And so when I came back to Silicon Valley, I had one rule. And that was that I would

not form a company that was based on my own idea. I would talk to as many people as possible, put myself out there in the universe, and see what came up. And I wanted to do that in the field of health because I wanted to not just build a great company, but also build a great company that could help people. All right. Let's talk about the world of health because I guess there's this doctor in Canada named Rajpal Atariwala, and he like already in like 2010, he started experimenting with he bought, he took a loan, he bought an MRI machine to offer MRIs. to people who wanted them, just voluntary MRIs who are willing to pay for them. How did you hear about this guy? How did you come across him?

Well, in my own explorations in the field of health, I was doing a lot of self-reflection on my own health. And I was doing what a lot of people do, which is we work hard today in order for a payoff in the future. And I had been working seven days a week for many years, not exercising, exercising, not eating as well as I should. And I was doing that because I believed that myself or the world or someone could benefit from sort of the fruits of those efforts. But I never really understood the other part of that equation. And so really it started with this journey to figure out, well, what's actually happening underneath my skin? Is this bargain that I'm making a worthwhile investment? And that's when I met Dr. Adirwala. How did you meet him? A friend of mine introduced

me to him. They said, hey, there's this guy in Vancouver who does full-body MRIs. You should go do one. Correct. And being the entrepreneur, I sort of jumped on a plane and rocked up to his clinic, and I did one of these scans. And what did you think? And I thought it was incredible. I had learned more about my health after one hour inside this machine than the health system had told me my entire life. I was nervous going in. I learned, thankfully, that there was nothing crazy and life-threatening going on. And I would say the thing that had the most profound impact on why I wanted to work hard to bring this scan to as many people as possible was the incredible peace of mind I got. And I felt like I was bouncing off the walls for weeks afterwards. I knew something about my health that no one

else that I passed in the street really knew. And that gave me tremendous happiness to know that if I had headache, it was because I didn't sleep enough. Or if I had some pain in my stomach, maybe I ate something bad, but it was nothing more serious than this. And in that moment, I really realized that there was this potential screening use case for MRI machines that was a thousand times bigger than the diagnostic use case. So I had that iPhone moment again, but in an entirely different field. And I knew from that moment that this is what I wanted to devote my time on. And this guy, Rajpal, is a radiologist, right? Correct.

And he had this clinic called the AIM Medical Imaging Clinic in Vancouver, so a one-off clinic where he was offering the service, Marty at that point for maybe a decade. What did you say to him? Did you say, hey, there's something bigger here? Like, do you want to talk about partnering up? Yeah, I mean, like most sort of scientists, Raj really enjoys and was great at fundamental research and really understanding the physics of MRI.

And he had a small, I guess, like side business in doing these scans for people I heard about it from word of mouth. But it was clear that the opportunity was much bigger and he needed someone obviously to partner with that understood or had experience in scaling out businesses. In other words, he was probably mainly doing cancer patients. But occasionally private people who were not cancer patients, just wanted scans, would come in. And that was sort of a side business. Correct. Okay. And it's interesting because I think of products that are designed for people with conditions like continuous glucose monitors are designed for people with diabetes to manage and to monitor their glucose levels.

But in the last five or six years, companies that make these products have figured out that you can actually market them to people who are not diabetic who are healthy, who also want to monitor their glucose levels because glucose levels are connected to metabolic health. you're looking at this machine and you're thinking there's a second use for this. It's not just for people who are diagnosed with cancer or, you know, maybe have a fracture or, you know, an injury. You can actually maybe just use it as a diagnostic tool for anyone. Correct. And in fact, there's two really interesting and impactful use cases. The first is to understand if there's anything going on under the skin that might be life-threatening. Yeah. And then the second, which is less obvious, but in some ways way more powerful is to have very detailed pictures of the inside of your body

so that we all as individuals can understand the impact of the way we're living our lives on what's happening under the skin. And as humans, we're really bad at making decisions today for some sort of theoretical payoff in the future. And this is why, for example, on cigarette packets, they have pictures of sort of ugly disease lungs, is, you know, they hope to shock us into making changes to our lifestyle. We scan every employee in our company, and we've had a few people that were smokers, and there's nothing that encourages people to quit more than seeing actual pictures of their own lungs and the inflammation that smoking is causing.

And so we do that writ large across the entire body. So 2018, I guess the two of you co-founded Pernuvo, and it began as one office in Vancouver. And so initially, I mean, I have to imagine this was a small business, in part because, I mean, the machines are expensive, but also you need radiologists to be part of this process. So tell me about the plan. Like when you went to Raj, you say, look, let's start here in Vancouver. But eventually we can build a whole series of clinics around the country, around the U.N. North America, maybe beyond where we can make this work. Was that how you kind of pitched it to him? Yeah, I think there was really two big challenges in building the company. The first was operational,

which is to say the single biggest assumption underpinning all radiology today is that you only ever look at one part of the body at a time. And this is a throwback from 150 years ago when we just had an x-ray plate that they put behind your body to take a picture of what was happening inside. And so there's a huge operational challenge in overcoming that. And there's many things that needed it to get built from the ground up. And that involved a lot of time, money, and as you mentioned, radiologists who believed in what we were doing. The second challenge was really a mindset challenge. We went out to investors and we really struggled to raise money to start executing on this vision. You struggle to raise money at the beginning. Why? Because I'm thinking, this is a no-brainer.

You're going to a bunch of investors and you're saying, hey, people are going to do this. They're going to want MRI. these machines are expensive. They cost millions of dollars, but they're going to pay for themselves in a matter of months because you're going to have people get scanned, their full body scans. Why was their skepticism? What do the investors say to you initially? Well, the primary reason is because people had tried doing screening in the past. 20 or 30 years ago, you could go to a shopping mall and there were businesses that had CT machines. Oh, yeah. But that's different. That's radiation. 100% a completely different business, but in some ways it's soured in the minds of many physicians the potential for screening asymptomatic patients. And so every VC fund either had an MD as a partner or had a personal physician that they would ask for advice. And universally, I imagine at the time these physicians were saying, this makes no sense. You eventually were able to raise about a million, a little over a million dollars to get this off the ground. And I guess the idea was to open the first office, real office, in the Bay Area.

Is that right? Correct. I put money in and then we raised some money from a bank, actually, believe it or not, in order to bootstrap this clinic in Silicon Valley. Now, of course, when we're in the Silicon Valley, a lot of VCs who were interested in the field of health came in for scans. and there's something about seeing the technology firsthand that's really, really hard to communicate through a pitch deck. We're going to take a quick break,

but when we come back more from Andrew on pre-newvo's growth and the criticism from the medical establishment that's come along with it, stay with us. I'm Guy Raz, and you're listening to How I Built This Lab. It's the holiday season, and while that usually means more time with family and friends, it also means more food, and for a lot of people, that means more bread, more carbs, and a price to pay after the holidays are over.

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my listeners are thinking. They've sponsored quite a few episodes of this show, and it's just an amazing tool for collaboration and working with teams, and so far, we've been really happy with what we're seeing. If you haven't heard of it, Mero is this incredible online workspace. Our team uses Mero for a lot of our own brainstorms and processes, and I think it's super useful to try it out if you want to build something great with your team. Now, I want to talk about a part of Mero that many of you probably have never heard of before. It's called the Miroverse. Sometimes starting work on an online visual workspace can feel overwhelming, but with Miroverse, you can select pre-made boards for pretty much any use case. It saves you the hassle of building from scratch.

And what's really cool is that a new template has just been added. This time for me, we partnered with the folks over at Miro to create a how-to-build-a-past Miroverse template to help kickstart your journey to making a podcast. Go to Miro.com slash H-I-B-T to check out our Miroverse template for yourself. That's M-I-R-O.com slash H-I-B-T. And I'm excited to hear what you think. This is Thomas Silver from St. Petersburg, Florida. My favorite, how I built this, has got to be Tate's bake shop. Kathleen King is every entrepreneur's dream, her whole story of starting with a roadside stand.

and also her perseverance in times of almost complete failure. She rebuilt her business and continued even in rough times. Thank you so much for your show. It is awe-inspiring and keeps me motivated. If you want to share your favorite episode of How I Built This, record a short voice memo on your phone telling us your name, where you're from, what your favorite episode is, and why? A lot like the voice memo you just heard.

and email it to us at hibt at id.wondery.com. And we'll share your favorites right here in the ad breaks in future episodes. And thanks so much. We love you guys. You're the best. And now back to the show. Welcome back to How I Built This Lab. I'm Guy Raz. So my guest today is Andrew Lacey, co-founder and CEO of Prenuvo.

It's a company that's using full-body MRI scans to help patients catch chronic conditions early before symptoms even appear. Let's talk about the technology for a moment because you mentioned that traditionally people get an MRI in a certain part of their body, right? And I believe full-body MRI scans can take three, four hours. You basically have machines that are,

you know, I can't imagine too many companies make these machines, GE and others make these MRI machines. But you're promising a full-body scan in an hour. So how are you? able to do that, especially given that you had a bank loan and a little bit of money that you put in? Well, the time has got a lot faster. So the initial scan we did was an hour and a half, which was still much quicker than three or four hours, but not quick enough for people to do this routinely.

We do this really through a couple of things. First, we have hardware that's custom built for fast, whole body diagnostic quality imaging. So the field strength that we use is a 1.5 Tesla, magnet, but we put in it sort of a Ferrari engine so that it can run a lot faster. The second is that we really understand the physics of MRI, and we've spent a lot of time tailoring our acquisition protocols to balance speed and image quality and heat that we put into the body during the scan. All right. So you start this clinic, and the idea, the promise is, and we know this, by the way, this

is not what you're saying. We know this from science. is that the earlier you catch cancer, the more likely, like, cancer is an early detection problem. If we can detect all cancers in stage one, you can cure most of them. The challenge is that most of the time, cancer is not detected until it's symptomatic. And by that point, you're in stage three or four. The idea here is that a full-body scan could possibly detect diseases in their early phases, and that will enable a patient to deal with them earlier.

Is that right? Correct. And what's really unique about these scans is when you're coming for a scan, we scan your liver something like 13 or 14 times. And we're actually filtering for different tissue composition. We're filtering for blood, fat, protenacious tissue. And there's one really, really special filter that you need to have very, very good hardware to do,

which is a filter for hardness. And what we know about cancer is, well, not everything that feels hard is a cancer, all solid tumors are harder than the surrounding tissue. And so it enables us to be a lot more sensitive for very early stage cancer. And that's why the vast majority of the cancer that we catch is actually stage one or localized to the organ of origin. So we're able to do what women do for their breasts, which is feel for lumps. We can do that digitally with these machines through the entire body, including the parts that you can't feel very well yourself and be able to do

that at a quality that enables us to detect these lesions very, very early. Once you open the clinic in San Francisco, you begin to attract interest and then funding. So let's kind of dive into what you got here. And full disclosure, I did one. I paid for it. I did it a couple months ago. And I thought it was actually incredible. But I'm not here to endorse it. I'm here to ask you about the science behind it and also the criticism behind it. This is a voluntary thing that people can do it. Ranges in cost, I think it starts in the $500 range or a little bit more for a part of your body all the way to almost $3,000 if you want a full body scan. So it's not cheap, but you get this very comprehensive look inside your body. Let's start with the opposition. There is an overwhelming amount of opposition to what you're doing from the medical establishment. I have not found. really any official endorsement of what you're doing. And in fact, many public health experts are like, this is not good. People should not be doing this. It's very expensive. Your regular physical with your doctor, you know, cancer screening through blood tests and stuff can find out most of this stuff. These kinds of scans only lead to unnecessary procedures when there's false positives. So let's

talk about this. I mean, over, you know this. Overwhelmingly, doctors, the American College of Radiology, they oppose this lockstock and barrel. Friends of money were doctors. We're like, why are you wasting your money? Why are you doing this? So, I mean, there have to be something to these. These are, these are board certified experts. Well, I think it's a bit disappointing. And actually, I don't think you've fairly characterized what they say. And this is an important point. So fine, please. So most of those statements, are along the following lines, there is not sufficient evidence to show that these are ready for population widescreen.

And the problem is that these statements are being made. This is a scientifically accurate statement that's being made in a consumer forum where it is misunderstood the way that you did, which is that this is not helpful for the individual, and that's not true. A lack of comprehensive, large-scale, long-term evidence is not... Is that the absence of data? You're just saying there is no data. Exactly.

And I think these statements that were made actually have also been made about pap smear between when it was invented and when it was adopted, mammograms. So this is a very, very natural point in the journey from a potentially breakthrough screening technology to the point at which it inevitably is adopted, and I hope it won't take 30 years. I want to point out some important distinctions, which is a lot of radiologists oppose this, certainly around CT scans, which this is not. CT scans, that's radiation. You're exposed to radiation. MRIs, it's just magnets. You're not exposed to any radiation. So it's totally safe for the human body. I should just point out the distinction, right? I mean, just to make that clear. 100%. Yeah. And oftentimes when we hear criticism, we're not even 100% certain that the physician is referring to CT screening or referring to something that they might have seen elsewhere.

These are very new techniques that we're using on highly specialized hardware. It's very different to what might be available out there. And you really need firsthand knowledge to be able to form an opinion that is informed. Yeah. And there's no one that's really spoken out against these technologies that actually has experienced at first hand. In fact, most of those people bring their family members in and then start referring their patients. So it's interesting. There's a very good New York Times article about this. I don't know if you would say it was very good. It's very interesting a couple months ago.

And in that article, a woman, a doctor, Rebecca Smith binman, the director of radiology at UCSF. So she must be, no joke, a major radiologist. She's quoted as saying, I have a family history of cancer and I would not consider getting a full body scan. like pre-newvos. And I was, I was surprised, maybe surprised to hear that, but at the same time, I mean,

when you ask people like that, because you must encounter them, and you say, why? Do you understand their reasoning? Do you understand their point of view? I don't fundamentally understand it. Oftentimes we reach out and ask for them to come in

and visit a clinic and or meet with our radiologists, but unfortunately they don't, people don't always take us up on those offers. we've made thousands of potentially life-saving early cancer diagnoses or aneurysm diagnoses. We've provided a lot of clarity into very early stages of chronic disease that, if caught later, significantly affect both outcomes and costs for the health system. So I guess I'm a little bit surprised that there isn't more enthusiasm and inquisitiveness by the health system at large when I think everyone would acknowledge that we have a health

system that is just tremendously reactive and is not really meeting our needs. I guess my question is, do you care? I mean, to get an appointment, you know, it's hard now, right? Your scaner beds are probably just full all day. There's massive demand. So do you really care what the medical establishment thinks? Absolutely, I care because patients trust their physicians. And if you are interested in getting one of these scans and you go to a physician and your physician provides an uninformed opinion that discourages you from doing it, then you have potentially missed out on an early diagnosis or greater insights into your health. That's why we invest so much time in educating physicians. That makes sense because I have to admit, when I, before I got one,

I told my doctor and friends or doctors and they were all like rolling their eyes. And I kind of felt like an idiot, you know, like, is just a waste of money and time? But I went through it. And so that makes sense. You need to convince them that this is worthwhile for people who want to do it. Sure. And I think there's kind of two levels of evidence. Level one is, is there enough evidence to inform that this is a helpful technique for a given patient? And here we can talk to the types of things we see and how early we see them and the sorts of risks and how impactful they might be on a given patient.

The second level of evidence is, can we show that? that there is a reduction all causes mortality over the long run for people doing these screen screenings routinely. And we're working to collect that evidence, but it's implicit in the nature of the question that that's going to take a long time to prove. There have been a lot of, you know, back and forth recommendations over the years about early, you know, colonoscopies, for example, of what age to get them or mammograms, etc. And how often to do them. It's gone back and forth. Sometimes it's do it. Sometimes it's don't. Every five years, every three years, stop, you know, wait until you're 60.

In part because sometimes when there is cancer detected, there's major interventions that can, you know, render people, you know, double mastectomies or, you know, prostate cancer. Things that are sometimes the arguments, the interventions are too aggressive and unnecessary. And, you know, the same Dr. Smith Binman in this article said, look, the problem is is that these screenings will find early cancers, but not all of those instances of cancer will. develop into a devastating disease. And she goes on to say, look, you know, for a small number of patients, detecting and treating early cancer will have a profound benefit. But the number of benign tumors in our bodies so outnumber the number of aggressive tumors. And so the concern is that it's going to result in overly aggressive treatment when none is necessary. And that's a, you know, I don't think that's an illegitimate criticism. I mean, I think it's an opinion. I'm not aware of any

clinical evidence cataloging this vast quantity of benign tumors that we have in our bodies. But it's also an argument that makes sense when you start to consider these interventions at a population level because at a population level, we're all a statistic. But at the individual level, we only have one life. If we lose that one, we don't get a do-over. And so the way we might make decisions as individuals is fundamentally different because of that fact. We're going to take another quick break. But when we come back, Andrew shares his vision. for prenuvo's future and its potential to reshape American healthcare as we know it. Stay with us. I'm Guy Raz, and you're listening to How I Built This Lab.

Welcome back to How I Built This Lab. I'm Guy Raz. So earlier this year, I actually had my very own pre-newvo body scan. And just to be clear, I paid for it. I didn't get it for free. And my guest today is the co-founder and CEO of the company, Andrew Lacey. I'll talk to you about my result because I got it, Don. knock on wood, no cancers found. No, but what they found in my case was some degradation of my cervical spine and my neck. And that's, I think more and more of this is being found because of iPhones.

People are leaning over reading their iPhones. It's screwing with our necks. Even sitting here in my studio. And that actually prompted me to go to physical therapy and to start a new regimen to try and deal with this. Because I don't want to have compressed. nerves in my neck because it can affect your mobility. You can start to feel it in your arms, and I'm not an old guy. So that was super helpful. I actually, I actually loved that. I think one of the really fascinating things that we have discovered, as you started to image

more and more patients, is we can see oftentimes at very early stages of chronic disease 10, 20 years before you might ever feel symptoms. And spine is a really good example of this. When we open in Silicon Valley and we got patients that were in their 20s coming in for a scan, we could show the spine to a radiologist and ask them to guess the age of that person, and they might guess that they're in their 40s. And long-evity is so closely linked to mobility. Once you lose your mobility, you don't live much longer. And so this is a life-changing insight to get early on when you can do something about it that's as simple as just changing your lifestyle.

Yeah, I mean, as I say, you know, seeing changes in my cervical spine, has led me to go to physical therapy and also to take mobility exercises really seriously because I've been so focused on cardio strength training that I've neglected stretching. But seeing this early, I can see where this will go. And oftentimes what a physician might say, especially might say, is, well, you know, a lot of people might have these problems and never experience pain. And that's actually true. But we can still figure this out by looking at your spine.

Some people have what's called a congenally narrow spinal canal. That means there's not a lot of extra room in a spinal canal for anything other than the spinal cord. And those people, when they start getting these slippages, they're the people that will experience pain, you know, 10, 15 years down the track. Yeah, no. So I loved it from that perspective. And I have to imagine that in most cases, it's not detecting cancer. The scans are not detecting cancer. That's correct.

We detect cancer or aneurysms in maybe one in 20. to one in 25 people depending on the location. So, all right, let's talk about price point. Okay. I mean, it's not cheap. But if you think about it, you know, from a holistic perspective, it's a pretty good deal. You can get a full body scan for under $3,000. And if you were to do this and you had cancer, like, God, the costs are astronomically higher. How can you, one of the questions I had from a friend of mine who is, you know, very prominent doctor in the Bay Area. I don't understand how they can do this at this price point. Just the radiologist, the cost the radiologist to read these scans is going to be so high. Are they using radiologists in, you know, in the Philippines or in countries where the costs are

just so much lower? How do you do that? We built a highly optimized business for a whole body screening. So we have one radiologist that looks at the entire body. They're trained in identifying what they see in every single organ, and then we have subspecialties that can chime in if there's something abnormal and they need help. And that, importantly, we believe can yield much more useful insights because our bodies are not a collection of parts, they're a system. And we can learn a lot about how, for example,

your heart is working by looking at your brain. We can tell a lot about even things that we can't see with MRI, like blood pressure or diabetes by looking at the effect on the liver. And so by looking at you as a system, we believe that we can provide a more accurate picture of your overall health. And are the machines, I mean, you know, there are now, I mean, you guys really have pioneered this. Now they're competitors.

Presumably the machines aren't that different, but what differentiates what you guys offer? Is it that there's different technology? Well, the machines are different. So you can't do this. regular imaging, you do really need special hardware and software. And that's what makes it unique. And you have proprietary machines or the machines also sold to other clinics? The machines are custom built for us. We don't build them. We're not MRI manufacturers. As you mentioned, there's only a few

companies that do this. So we partner with two companies to produce the machines that we use. All right. Let's talk about access, right? And this is not your job. You are in business. You're not you're not running a charity, but ultimately, you know, and you know, one of the critiques of this is that this is only for wealthy elites who can afford to pay, you know, a thousand to $3,000 to get this done. And so it's not accessible to most people. Presumably, I mean, it's not in your business interest to keep this expensive, that it's in your interest in the long term to make this cheaper. Well, let's talk about who's using the service and then how we're working on

cost. So there's an incorrect assumption that most people make, which is the types of people that are really attracted to this are sort of the health and lifestyle optimizers. The biohackers of the Silicon Valley. And for sure, most anyone that considers itself, the biohacker, has done one of these scans. But the single biggest category are people that might have had cancer and worried that is coming back, or they have a strong family history of cancer, aneurism, or disease. And for them, not being screened is obviously affecting their quality of life. The second biggest category are people that have actual symptoms, but they're indeterminate. They might have headaches or abdominal pain, particularly women that might have abdominal or pelvic pain, and they don't know what's

causing it. And the health system is not doing a good enough job, diagnosing the condition. And as a result, they're sort of without peace of mind. And they come to us to get peace of mind or to get treatment a lot earlier by diagnosing the condition faster. So when you think about this business and where it's going, where do you want to get the price point down to? Our goal as a company is one day that these are a sub-five hundred dollar scan. It takes probably about half an hour or less, and they're available most everywhere. Do you think that once somebody gets a full-body scan, it's worthwhile for them to also get a second

read by there, maybe a radiologist they may know? Or is the information from your radiologist so good that that's not necessary? Well, we built the service in a way that that's an option. So it's really important that the images that we take are clinical diagnostic quality and recognizable to any radiologists who specializes in a certain part of the body. So our head images are equivalent to what you would get if you had a dedicated head MRI. And that enables the potential for a second or third opinion. And if you have something that's very concerning, I don't see why you may not want to get a second or third opinion,

because now we're no longer looking at you through a screening context. We're looking at your body through a diagnostic lens. Previous attempts to do this with MRI used what we call non-diagnostic imaging, which were as poor quality fuzzy pictures. and it was most radiologists didn't want to read it in the first place and certainly didn't want to provide a second opinion. So, Andrew, I mean, it sounds like from your perspective, obviously I can, I know I can hear the frustration in your voice about the pushback from the medical establishment, right? But when you're sort of going up at 35,000 feet and looking down at this, are you telling

yourself, this happens with every medical technology? It's always happened. And we know in the end, we're going to be vindicated because this is going to help people discover diseases way out in advance and it will be embraced over time. Yeah, I think my enthusiasm is informed by the patients that I meet every day where we have a positive impact on their lives. In some ways, although what we're doing is very innovative, we have a really, really simple approach to marketing, which is let's just provide the most accurate clinical diagnostic screening exam. And if we do that people will tell other people and then the business will grow. And I'm sure your listeners will have probably heard about us from perhaps celebrities that might have talked about us.

Now, a lot of this came about just because we opened in LA and we were doing a great job. And eventually someone told someone who is a celebrity and has a big social voice and they come in. And then they'll tell their friends that also happen to be celebrities or people with a large reach. and that's a large part of the reason why awareness of these scans has really taken off this year. Yeah, Kim Kardashian famously did one earlier this year and posted on it. Have you ever had a bad review? I mean, I'll just say, I went, everyone was so nice, and the snacks were gray, and the coffee was good, and it was a very easy experience. But have you had people?

Because, look, I mean, doctors offices are stressful for the people who work there. And look, oftentimes, I'm sure people have experienced this. They're just unfriendly when you go there. But have you guys emphasized, like, be friendly, be courteous, all those things to the people who work at the front desk? Absolutely. And it's not just because that's how I would like to be treated. Actually, it's because of something that's very fundamental to our healthcare system, which is going to a healthcare facility is scary. Yeah. And it's scary because we have a healthcare system that's very reactive. And if we're going to get diagnosed with anything, it's going to be by definition advanced. Yeah. And scary. And we are building a business where we want to do. diagnose things early. We want to be like the routine dental checkup, but for the rest of your body. And if you go to the dentist every six months, most of those people are not afraid to go.

Because, you know, they're not. It's just getting a clean and hopefully. They're getting a clean. Maybe they need a filling, but the chances of needing a root canal is pretty remote. Yeah. And so we have to, we exist in this ecosystem where disease is defined in such a scary way that we go out of our way to make sure that the visit itself does not trigger any of that fear. So our facilities don't have any white walls. We don't have anyone wearing, you know, lab coats or medical outfits. And all of this is frankly because of the fact that, you know, we operate in this ecosystem where disease is scary. You can watch Netflix while you're getting your MRI, literally. That's correct. And, you know, to give you an example of

how that helps, the average MRI procedure, about 10 to 15 percent of people can't get through it without pulling the escape hatch. Because it's just you have to be still for an hour. Correct. And at Pernuvo, we have about 1% of people that can't get through a scan. All right. You guys raised $70 million in October of 2022.

Your growth has been exponential. Tell me about the plan. I mean, when we talk in 10 years, Andrew, Prunvo is going to be all over the United States, all over the world in every city. What do you imagine? I have hundreds of people that are working hard so that one day this is standard of care everywhere. That means that there's a facility down the road for you, just like there might be a Starbucks

and you turn up, you get maybe a 10, 15 minute scan. And probably by the end of the scan, we already know if you have something that we have to walk you through or not. And if not, then you go about your life for another year. And that's a world where we've redefined the definition of disease from scary to maintenance. and people don't ever have to suffer through their lives not knowing what's going on under the skin. How big do you think this industry can get? I don't see a reason why not every single adult in America shouldn't do one of these scans every year or two.

In fact, to just screen for cancer in the US using the techniques that we use, probably to scan every person in the US every two years would cost something like $60 billion. We spend $130 billion on late-stage cancer drug. every year, let alone the obviously huge impact of people passing away from this horrible disease. So the economics are already there for these types of preventative screening interventions to be hopefully adopted ever in the US and not only will save lives but should save money for the healthcare system. That's Andrew Lacey, co-founder and CEO of Pre-Newvo. By the way, pro tip for anyone listening, because I just had a scan.

British baking show. That's what you want to watch. Everybody's happy. It's a world that I want to live in. So that's my pro tip. We have some people that play comedy, and we've learned actually that that's not a great choice because they start laughing and then the images of the head are not quite as clear.

Hey, thanks for listening to the show this week. Please make sure to click the follow button on your podcast app so you never miss an episode of the show. And as always, it's free. This episode was produced by J.C. Howard with music composed by Rumpteen Arablewee. It was edited by John Isabella with research help from Alex Chung. Our audio engineer was Neil Rouch.

Our production team at How I Built This includes Carla Estevez, Casey Herman, Chris Messini, Catherine Seifer, Carrie Thompson, Malia Agudelo, Neva Grant, and Sam Paulson. I'm Guy Raz, and you've been listening to How I Built This Lab.