The Checkup with Doctor Mike - Do You Need A Full Body MRI Scan? | Prenuvo CEO

Episode Date: March 16, 2025

I'll teach you how to become the media's go-to expert in your field. Enroll in The Professional's Media Academy now: https://www.professionalsmediaacademy.com/Fact Check #1: 44:50 - https://www.youtube.com/watch?v=W_ZGhRZee9AFact Check #2: 1:14:49 - https://youtu.be/OzvtIXiHjqg00:00 Intro02:20 How He Started08:00 Who Has Access?13:39 Does Prenuvo Actually Save Lives?23:10 Scans Causing Anxiety / False Positives31:46 Harms Of Scanning39:30 False Promises Of Scanning46:52 AI Spine Research56:45 The Psychology Of Good Health1:00:38 Prenuvo vs. Traditional System1:09:53 Brian Johnson / Longevity1:15:15 Biased Research1:25:47 Kim Kardashian's Endorsement1:32:53 Changes He MadeHelp us continue the fight against medical misinformation and change the world through charity by becoming a Doctor Mike Resident on Patreon where every month I donate 100% of the proceeds to the charity, organization, or cause of your choice! Residents get access to bonus content, an exclusive discord community, and many other perks for just $10 a month. Become a Resident today:https://www.patreon.com/doctormike​Let’s connect:IG: https://go.doctormikemedia.com/instagram/DMinstagram​Twitter: https://go.doctormikemedia.com/twitter/DMTwitter​FB: https://go.doctormikemedia.com/facebook/DMFacebook​TikTok: https://go.doctormikemedia.com/tiktok/DMTikTok​Reddit: https://go.doctormikemedia.com/reddit/DMReddit​Contact Email: [e-mail] Producer: Doctor MikeProduction Director and Editor: Dan OwensManaging Editor and Producer: Sam BowersEditor and Designer: Caroline WeigumEditor: Juan Carlos Zuniga* Select photos/videos provided by Getty Images *** The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/health professional **

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I wanted to go a layer deeper. Celebrities like Kim Kardashian have jumped on the wave of support of a new kind of preventative care. It comes with a hefty price tag. We're talking about pernuvos' full body MRI scans. One could hypothesize that I'm a visitor from another planet and on my planet we screen everyone. You know, I take you back to my plan and say, well, let me propose to you that you don't screen anyone. My population would laugh you off the planet. Why are there no major United States organizations that are recommending this?

I don't think there's any evidence that consumers consider themselves harm by these screenings. The burden should fall when you're testing healthy people to prove that it causes benefit, rather to prove that it causes harm. Welcome to the Checkup podcast. Today, my guest is Andrew Lacey, CEO of Pernuvo, a couple of company that's at the forefront of whole body MRI scanning, a technology that aims to catch potential health issues before they become serious problems. You may have recently seen the company's technology in headlines or on Kim Kardashian's Instagram, spurring excitement, intrigue, and even some controversy. You see major medical organizations, including the American College of Radiology and the United States Preventive Service Task Force, do not recommend routine

whole body scans for people without symptoms or specific. risk factors. There are concerns about false positives, unnecessary follow-up procedures, the cost-effectiveness, and most importantly, if the proposed benefits actually outweigh the risks. Despite that, advocates of this technology argue that those concerns are overblown and that the scans can provide peace of mind and potentially detect conditions early when they're most treatable. In today's conversation, we dive right into addressing those controversies head on, as well as the science of the scans, and how Pernuvo is handling being at the forefront of this emerging field. As a reminder, if you hear this sound, that means there is a fact check

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a gesture made for oneself. Discover the new fragrance. Mutine, now available in Canada. You're a business person. You were working, starting multiple businesses, I believe it was four at the time. And then you found the passion in treating, talking about, and fixing the healthcare space. How did you get there? Well, the starting point really was I was a serial entrepreneur for probably the first 20 years of my career. And I was a typical entrepreneur.

I didn't sleep enough, I didn't eat enough, I didn't exercise enough, I had a lot of stress. Some of those things, by the way, is still true because I am still an entrepreneur. But I remember one day just waking up and looking in the mirror and saying, you know, hey, we're doing this to make the world a better place. What guarantees do I have that I'm going to be around for this future that I'm trying to create? And in that moment, I had just taken my car to a new body shop. Okay. And my car was asymptomatic. So you were going for a preventive checkup?

I was going for a preventive checkup of my car. And what I got back from this shop, maybe they all do it this way now, but I got a 30-page report of every component in my car, the engine, the transmission, the clutch, the brake pads, the wiper fluid. You know, what was running low, where were the brake pads wearing?

How was the way I was riding the clutch sort of like affecting, you know, the wear and tear on that component, how I could drive my car better, what needed to replace now, what could be replaced in the future, what should I watch? And I just had this moment of complete dissonance. Why on earth do I have this like 30 page report about my car and really understand deeply how it's performing and how it's tracking in its health? And I don't have that same picture for myself when I look in the mirror. My understanding of my health was sort of skin deep. Interesting. And that really started me on this journey. So, you know, I had thought

I had learned a thing or two about building businesses. And I had, you know, at this, at this point, I was really trying to solve a problem that I have for myself as a person. And that time were you having a relationship with a primary care doctor doing checkups or not really? Not really. I mean, I had a primary care. Like most people that have a primary care doctor. Well, these days, it's not most people, sadly. I wish more people had a primary care doctor. But, you know, my experience had been pretty underwhelming in the context of preventive care. So, So, yes, if I had a, you know, if I presented with a flu or some sort of acute problem, usually I could get some relief from visiting a physician.

But my annual physical usually went along the following lines. Tell me about what you do. You know, I'm stressed. I don't eat enough. I don't exercise. And the answer was generally after, you know, some sort of cursory pushing a prodding on my abdomen, well, maybe you should think about, you know, working on your stress levels, eating better and exercising more.

So lifestyle modifications. Which I'm not saying is the wrong answer, but it was also sort of, it was like a, it was a checkout that was absent any real unique insight that I didn't really know myself. You know, I wanted to go a layer deeper. Okay. And that was the journey that I went on search for an answer for. And that took me of all places from Silicon Valley up to Vancouver, Canada. Wow. Okay.

How did that search form? Were you Googling? Were you talking to friends? Talking to friends. Okay. And I had a friend of mine that had a friend of mine that had. had gone to TED, which is in Vancouver, and with her mother the year before, and they had heard about a doctor that was doing an early precursor to what is now the Prindgo scan.

And she had gone with her mother, and they had diagnosed a quite large aneurysm in her mother that in the week she got treated, her sister, so the arty of my friend, had passed away from a burst aneurysm. So I just thought it was crazy that this could happen. Now, someone in the medical profession like yourself, probably, that's not so unusual, but for a lot of consumers, I mean, a lot of us, we don't walk around thinking this could happen to me one day without warning.

And that uncertainty is scary. Right. And so I got on a plane and went and got one of these scans. And back then, you used to sit down the radiologist immediately after the scan and go through the results. It was kind of scary. And I was scared doing it. What might be fine?

I went out for a nice meal the night before, had a nice glass of wine and said, you know, I'm going to enjoy today because tomorrow my life's probably going to change. I'm going to get a full accounting of the abuse that I had sort of subjected my body to. And, you know, I sat down with the radiologist and I learned, A, I wasn't dying of anything that I didn't know about. B, I had some really clear insights into how the way I was living my life was sort of impacting

the physiology of my body. And most importantly and most profoundly, and the hardest thing to explain was I got this tremendous feeling of peace of mind. and I came back to San Francisco and that was the thing that stuck with me you know it was sort of I don't know if maybe some of your viewers have ever been skydiving or something you sort of like feel like you're bouncing around with a bit of adrenaline for a couple weeks afterwards or you see the world with a little bit more color that's sort of how it felt like you got a new lease on life I got a new lease on life and I sort of like you know I would get a headache and rather than

being concerned about what it might be just realizing it was a headache or a stomach pain is because I ate something bad and that voice that had been there not always consciously, but always, I would say subconsciously, was quiet for a period of time. And I thought that was incredible. And I couldn't, so I couldn't shake the idea that I had seen something that was potentially the future of the way we should do practice medicine. So two weeks later, I went back and didn't leave for three or four months and sat down with that team and met a bunch of consumers and formed an opinion that this is something

that the world deserves to have access to. why do you think we didn't have access to it at that point or actually we sort of still don't in many respects right if unless we're going to a private institution to get it it's not covered by insurance it's not in the medical establishments yeah i mean you can do them so here i guess at memorial stone kettering or you know in boston and harvard or stanford in the bay area you can do these scans are often offered to people that have a cancer predisposition syndrome so So a syndrome like Luframany, Phancomia, anemia. Multiple endocrine neoplasia syndrome.

And they are covered by insurance, but they billed at something like $50,000 to $100,000. They take three hours and they often require a general anesthetic just for you to tolerate the procedure of lying in the machine. So what was different here was, you know, solving for a unique combination of hardware, image acquisition protocols to bring these scans down to 100 an hour. so it could be offered in a sort of comfortable consumer context. And that's what this team had first done up there in Canada. And how does the current Pernuvo scan decide who is a patient or who is a candidate? Like, for example, I'm very pro being preventive when it comes to health care. And there's many tests that I offer in my practice that are sort of agreed upon screening

programs that we do, colon cancer screening, pap smears for cervical cancer. blood tests for screening for diabetes. And for the audience, when we say screening, that's generally asymptomatic people, meaning no symptoms recommended to everybody to try and catch this problem. And in the past, within at least my healthcare space, we've kind of titrated, for lack of a better term,

back and forth between not scanning too many people, making sure we're scanning the right demographics, so that we're not creating false positives, over diagnosis, over treatment. how does that play a role in the pernuvoscan world? Well, I think it's important to really understand the history of some of those tests that you just mentioned. So a pap smear, which now most physicians

would consider part of their standard of care screening, that was first sort of clinically validated in 1910 and it did not become part of standard practice until the 40s or 50s. Mammogram, you know, some of the first clinical studies were in the 60s, and it was not covered by insurance until the 90s. you know, low-dose CT screening for smokers took 20 years.

Right. PSA, maybe that's a little more controversial, but still took 15, 20 years to be covered. So what happened in that intervening period was we saw clinical use of these tools. And that clinical use very much made the evidentiary case for these to be eventually sort of adopted as part of standard of care. And I think that's the journey that the whole body screening with MRI, the multi-parametric approach that we're doing a prenuvo, that's the journey that it's on.

So right now, would you say the people who are getting scans are people who we're trying to create clinical validity for the future to be used in insurance programs? Like they're almost in a clinical experiment? Well, I wouldn't say that. We've, you know, it's a mistake to think of this as a test. This is a clinical practice that we run. So we have a team now of 50 radiologists that collectively read these scans. We have head of specialties that work with the company. Many of these people have Ivy League education. They're all board certified radiologists

in the states in which they practice. These are folks that have themselves 10, 15, 20, 30 years experience and they themselves have evaluated the hardware and the protocols that we're using and the clinical experience that we've had over those 14, 15 years. and they've decided to come work with what they believe is a very promising technology

and to play a part not just in sort of being the, I mean typically MRI radiologists that's the last image you get. Usually they're dealing with advanced disease. Yeah. And for the first time they're actually able to diagnose cancer at stage one or, you know, aneurysms or, you know, chronic disease before it even meets sort of the clinical definition of chronic. Yeah.

And so they're, so I would say there's a lot of clinical levels. behind this. And there are a lot of, you know, we're running clinical studies in a facility in Boston. We have run retrospective studies across. What kind of clinical studies? So in Boston, we're doing a prospective 100,000 patient study that includes a large social equity component. So a large number of the people that are doing that, that are undertaking that trial are folks that they're not paying for the scan. They would not otherwise probably be doing one of these scans. And so we're making sure that the population, that study reflects the average population. And that's a longitudinal 10-year study where we screen patients longitudinally and we follow the health outcomes.

So where we saw something that we considered clinically disease and what happened subsequently? Was that diagnosis validated? Was that patient treated? What was, you know, how did the use of this technology change sort of the trajectory of the diseases that were diagnosing? I imagine we'll report interim findings from that, but in reality, in all likelihood, you know, that's a five, 10-year study before it really starts to provide insights into how these scans might be affecting, for example, or causes mortality. Are you allowed to say right now that the pernuvo scan saves lives?

We make diagnoses, we identify lesions that are confirmed on biopsy that are early-stage cancer and we would we would consider that those are life-saving diagnoses um i can you can you definitively say that about any cancer no i mean can you say mammogram you know well i can there's a decrease in mortality by the incorporation although in the past when we overused mammograms we've actually run into an issue of creating what we separate from a false positive to an overdiagnosis which is a true diagnosis of a cancer of a condition, but in a state where it wouldn't have caused a problem. Because cancer is not really, like we use it as a catch-all term,

but there's so many different styles and variations of cancer where you could have a cancer that you could have, and then it spontaneously resolves, a cancer that you could have the rest of your life and you die with, not of the cancer, a cancer that is so fast in its progression that there's not much you can even do about it. So there's a lot of cancers that fall into this term.

Yeah, I think the only comment I would make and sort of where I was going at is all of those studies that sort of perform those assessments are 20 or 30-year studies because the only assessment you can make a statistical one. Sure. You can't diagnose a cancer and leave it untreated to see if it was a cancer

that was going to kill you. You can't design a study that can sort of prospectively sort of test that hypothesis. You can only do it retrospectively through statistics. And that requires decades. Yeah.

Yeah. So how do you sort of balance that line of waiting for that data versus recommending the test universally now? Well, you can sort of kind of make a circumstantial case, I'd argue. And I'll give you an example, pancreatic cancer. So there was a study, I believe, out of Hopkins a few years ago, where they essentially, I don't know the exact sort of method that they use, but they sort of dated the tumors in patients that had died of pancreatic cancer. And they were able to sort of determine

that the average age of a tumor at death was seven or eight years. And so obviously, you know, these tumors are dividing cells that grow geometrically and acquire mutations and then eventually metastasize and so on, right? So, you know, you might surmise that, therefore, that pancreatic tumor spend a certain period of time at stage one

localized to the pancreas. you know, might have spent of those seven or eight years, it was maybe like three or four years located to maybe the tail of the pancreas before it like migrated. Sure. And what we're finding at Prenuvo, so we've imaged now 100,000 patients and the vast majority of those patients were imaged for the first time. So, and we're finding cancer in probably about two to two and a half percent of patients. Now that's higher than sort of the expected incidents in the population. It's about 0.7, sort of age-adjusted, 0.7%. Is that because your test is more sensitive?

No, it makes sense because it's the first scan. And the first scan, remember, there's that 7- and 8-year life of that pancreatic cancer that we're sort of catching up on because no one's looked at it before. So we expect the high incidence, and we expect in a scene for a subsequent stand, a much lower incidence of cancer detection. So it's playing out the way we would expect. where we've found pancreatic cancer and in fact most cancers that we find

we're finding them early we're finding them localized we're finding them at a stage one in fact we've found more stage one pancreatic cancer we've found sort of metastatic pancreatic cancer and so it makes sense that the detection window for early stage cancer

is wider than it is for metastatic cancer because it spends more time in that stage and also they would already be sick with metastatic symptoms and be in the traditional medical system Correct. And that's what we're seeing. So when we find lung cancer, we're way more likely to see it at an early stage. Well, it's because they're asymptomatic. But we're not seeing because you're targeting, you're separating the symptomatic and asymptomatic population and

catching early things when people are asymptomatic. I get it. But we're not seeing, so we're seeing what I think is an expected rate of detection in the 2% to 3% given again, it's a first scan and we're picking up, we're sort of, we're just seeing more incidents because there's, you know, there's a higher cancer load that has been unscreened for previously, but we're not seeing like 10% detection. We're seeing something that feels reasonable and what we're finding is early stage. So, um, so again, none of this, you, you might still have to wait 20 or 30 years for a statistical analysis, but like the data would seem to point towards we are catching early stage cancer at a rate that would not indicate that there's a tremendous

lot, you know, a tremendous amount of indolent cancer that's not going to eventually become metastatic. Is not going to become. Correct. Like that, the data does not support that because we would have a higher detection rate than two to two and a half percent. Interesting. Yeah. So, like, I look at when I, in my office, scan someone with a CT scanner and MRI for, let's say,

something going on in their lungs, and then incident. capture something on their adrenal glands or I'm searching their abdomen for something and I catch something at a lung nodule, for example. And then I'm kind of stuck with what we call in the medical community an incidentaloma. Something that we incidentally found when we were scanning another part of their body. And a lot of times it puts me to a really uncomfortable position because there's sometimes no guidance on what to do. Or if there is guidance, it's based on lackadaisical or improper or imperfect data. So I'm not giving perfect guidance. So I'm not giving perfect guidance to the patient. And also it creates a lot of anxiety. Does that happen with these scans as well or not

as much? Wow. We might have to unpack that because there's a lot there, right? So, you know, not to be facetious, but, you know, the whole concept of insulin, or not really apply in the context of whole-way screening, because by definition, we're screening for everything. So there's no such thing as insinoloma, you know, we're looking for what we can fine. You know what? And then secondly, this, the, the technology that we're using that's available today is much better than what we've had in the past and certainly very different to CT. So we use a technique called multi-parametric MRI, non-contrast MRI. And we are collecting, for example, of the adrenals, we're imaging them 14 or 15 times. I had a number of different tissue

weights for protanaceous tissue, for fat, for fluid, for blood. And, in, you know, you're imaging, particular a sequence that requires specialized hardware to do across a whole body at scale like we are, which is diffusion. And diffusion enables us to digitally with the MRI look inside the body for areas of, this is going to sound very techy, high cytoplasmic ratio. And what that means in layman's terms is hard spots inside the body. And as you know, as a primary care physician, you know, we ask, you know, well, the guidance changes all the time, but like at a certain point in time, we asked women to do a breast self-examination. And the reason for that is, although not all lumps are cancer, all cancer are all solid tumors are lumps. And so we're

able to, with MRI, sort of essentially digitally feel inside the body for these solid areas. And I also think we walked back the breast self-exam recommendations. Yeah, that's why I want to be clear, because it changes. And actually interesting that we did walk it back because it did create a lot of unnecessary testing that happened down the line. Similar with testicular self-exams for young men, and we kind of move towards saying know what's normal, but not necessarily test yourself every time because it fueled some anxiety in people. For sure. And like I said, not every lump in a breast is cancer. For sure. But all solid tumors are more solid than the surrounding tissue. And that's what this scan is able to, this particular

sequence is able to pick out really well. And that's pretty new. It's been around for a while. If you get a prostate MRI, it includes these sequences, but the prostate is a tiny little sort of walnut-sized object. And on most equipment, you can do this sequence on a prostate. The hard thing is doing across the entire body under an L. And that sequence combined with all the other anatomical sequences where we're filtering for different tissue types

enables us to be a lot more accurate for distinguishing between lesions that are concerning and lesions that are benign. And adrenal lesions are a really great example of this. Most of the overwhelming majority of the benign adrenal legions are fat-containing lesions, and we see that because they have sequences for it. And so when we see a lesion, we are therefore able to restratify reasonably precisely whether this is something that's concerning or whether there's something that is not particularly concerning at all.

And we have a one to five scale with four and five being the increasingly concerned. lesions that we're finding and typically they're followed up. So I think the rate of follow-up today or certainly with the prenuvo protocols is much lower than what doctors have perhaps seen historically. That's not to say there aren't. There isn't follow-up that ends up sort of finding a benign lesion but it's just much lower than people expect. Hit pause on whatever you're listening to and hit play on your next adventure. This fall get double points on every qualified stay. Life's the trip. Make the most of it at Best Western. Visit bestwestern.com for complete terms and conditions.

When I found out my friend got a great deal on a wool coat from winners, I started wondering. Is every fabulous item I see from winners? Like that woman over there with the designer jeans. Are those from winners? Ooh, are those beautiful gold earrings? Did she pay full price? Or that leather tote? Or that cashmere sweater? Or those knee-high boots? That dress, that jacket, those shoes. Is anyone paying full price for anything? Stop wondering. Start winning. Winners, find fabulous for less. Yeah, like, I believe there was, I don't know if it was a meta-analysis or systematic review of 12 articles that looked at whole body MRI imaging. And they found 95% as a number that they used for sort of abnormalities on scans, broadly speaking.

You described this scenario where you went in and you got this clear scan and it gave you peace of mind. When you had a headache, you weren't concerned. But now, if you have a patient who did find something, even though you would label it as lower on a worry scale, that they have something in their bodies, now every headache is really scary. Wouldn't you say? Well, I think that how we should, it's sort of interesting, right?

Why was I not worried about the findings that I got about my car, my asymptomatic car, but I might be worried about the findings about my own. health. And I have a young child. And when my young child hurts himself, or herself, I should say, she'll tell everyone on the street what's going on. Every single person will know about her boo-boos and her band-aids and how things happen and all this sort of stuff. Something happens between youth and sort of middle age where now we don't want to talk about what's wrong, the average person. We won't, we'll sort of like ignore symptoms. We'll put things off. We'll tell ourselves we'll feel different tomorrow.

We will carry a tremendous amount of health anxiety. We weren't born with that anxiety. And I would put it to you that that anxiety was created by our reactive health care system. Because if everything is diagnosed late, if every cancer diagnosis is on average stage three, and therefore a life-changing diagnosis, why on earth would anyone go and look for a cancer diagnosis? Why would I want to subject myself to that? I'd rather live in blissful ignorance another day. So, you know, I often tell my team, you know, how do you know that we, how do we know we'll

be successful as a company? And, you know, it's easy to measure that by how many people we scan, how many patients we have and so on. I believe we're successful when we've changed the definition of disease, when it's not as triggering as it is today, because it doesn't need to be. Learning about your health does not need to be scary. It should be empowering, okay? So you think it's kind of the flip side of the equation.

that learning that if you have something in your brain and it might need follow-up in the future will actually reduce anxiety for people. I think you have to, I mean, the question you have to ask yourself is, this is a different approach to health care. This is an approach rooted in empowering people, providing knowledge, connecting people with providers

that share a similar philosophy. You know, identifying specialists that we can bring people to get appropriate care. and sort of like build a different transformative approach to health care, rooted in proactive preventative medicine. It exists inside, you know, alongside this reactive healthcare system. I think it would be a mistake to say, well, this, the reactive healthcare system has, you know, like created this anxiety, or the reactive healthcare system likes to follow everything

with an infinite number of tests. And because of those characteristics, we shouldn't do this transformative, preventative, of health approach. No. The reality is we should continue to invest and understand how these things can potentially be part of a transformed system and work to transform the system. Yeah. What about from like a standpoint of false positives, are you ever concerned about things popping up and it not ending up being a problem and down the line testing and the costs and anxieties that come with that? Well, no, I mean, for the same reason. The anxiety around false positive.

positives is a product of the reactive healthcare system, not a proactive approach to healthcare. I mean, I live in Los Angeles, and everyone in Los Angeles is talking about fires. If I brought, now I live on top of mountains surrounded by brush. If I brought a specialist to my house and they said, and I said, you know, tell me what's going on here. Then I say, well, I'm seeing some pretty concerning things. You got a bunch of brush around you, you know, there's a, you don't have a good escape route. You're on a cul-de-sac. This is, big problem. Right. But my house may never burn down. Sure. So was it a bad thing that they told me what was going on? I mean, my risk, you know, that information changed my risk profile. Is that a

false positive? That's a great question. I don't know. I think a false positive is them yelling fire when there's no fire. Yeah. And not warning you about risks. Because the reason why I'm a little, like a lot of people like to beat on our healthcare system, and I'm one of them. I'm one of the loudest outspoken critics of how we do things, especially when it comes to lack of transparency, lack of investment in primary care. But like, for example, there's a big, it's called Healthy People 2030. It's a federal initiative to try and get more people to go for their preventive health screenings, like everything that is proven in a very high level, like the high value things. Currently, I believe the last.

numbers that we have from this campaign is the number has dropped to 5% of Americans over the age of 35 actually go for their preventive screenings that we have available that the ACA has made that people do not cost share with their insurance so they cannot charge co-pays they cannot charge money it should be free to people who are insured and yet 95% of people aren't going but they're made available so can we say it's the health care system that's caused that anxiety for people or the fact that people aren't going for those things because of their anxiety? No, I think that's, I mean, it's a valid distinction. I can't answer that question.

I do think there's a lot of misunderstanding about false positives. I mean, well, as it relates to cancer, the only definitive test for cancer is going to be biopsy. So when we see a lesion, we restratified. We don't tell patients that they have cancer. We tell them that they have something concerning, and we'll tell them the level of concern we have, and we'll tell them the urgency with which we think we need to follow something up. And, you know, we've studied that. We did one clinical study up in Canada where we followed a number of patients

who ended up getting a biopsy as a result of a finding that we had on prenevo, and one in two of those had confirmed cancer. Now that biopsy, that one in two is a, that biopsy positive rate is better than mammogram. It's better than low-dose CT of the lung. And it's incredible given that we're not just like, get one organ we're looking at like the entire body. So, um, so I, so I, so I, I think it's a, it's hard to, is, you have to understand how you define false positive to figure out whether we're actually seeing anything. We're not. We're just restratifying. Um, and, uh, and at least it

seems like empirically when you do, uh, when a finding leastobopsy that those biopsy are being proven cancer, you know, more than you might expect or more than the average practitioner might expect from these scans. And the fact that, um, and the fact that, you know, we're finding these things to be cancer upon saying that they're suspicious. That doesn't necessarily mean that that would have gone on to be a problem. Is that true? For example, in Japan, they did this thyroid scan on everybody, and a lot of papillary thyroid cancers showed up. The number of papillary thyroid cancer in the country went up a lot, but the survival didn't change because it would have been a cancer that people would have not needed to treat, and they would have lived

the same length of life. So, like, just finding out, that it is in fact i cancer doesn't really tell the whole picture and kind of leaves me in a complicated place on guidance on what to give patients does that make sense no i understand and some practitioners will say hey we want to wait for that 30 year you know all causes mortality study to be concluded so we can really sort of have a very informed opinion about whether i'm going to recommend this for our patients and there are other factors and say hey you know there's a circumstantial case here. You guys are finding cancer and disease early. We know that the you know, the outcomes for patients are better, or we believe they're better if we find these

things early and on the basis of that I'm willing to send patients. And we have thousands of physicians that send us patients every year. Do you make a distinction between false positives and overdiagnosis? We don't. No. I mean, we don't. We haven't studied that. We haven't studied in the way that perhaps that 30-year study did in Korea. No, because the way that I think about the false positive rate, false positive is saying something is there that wasn't a problem, but in the overdiagnosis state is saying something that's truly there but wouldn't have caused a problem, which you would need a longer-term study for.

So, like, how does that play into a role for someone who would want to get a scan? Can there be harms from getting these scans? Well, I guess if I follow the definition you just gave, we are not, we neither create false positives nor either diagnosis because we don't diagnose. We just restratify things that we see. But isn't that a little bit of a cop-out? Like if you say, hey, you have something concerning, you may have not diagnosed it, but you said it was concerning. I don't know. I think it's, I think it's important to be clear about our definitions. I've got, this may be oversharing, but I've had three colonoscis and four polyps. Were those four false positives? I don't think they're false positives. They were biopsyed, and they were negative. Right.

So when you take out a polyp, you decrease the risk of that polyp turning into something. So you're actively also acting on a risk. Right, because polyps can turn into cancer. But not all polyps turn into cancer. Correct. So you're performing the procedure to decrease the risk. So I don't know. I just think it's, you know, there's a lot of, a lot of people want easy sound bias.

And I think it's a, this is a, it's a complicated. analysis. And to be fair, I think one of the challenges of screening is it's probably the most complicated thing to analyze the impact. I mean, it's sort of a bit sad in some ways that, you know, if a pharma company develops a new drug that makes an ovarian cancer patient live for, you know, on average, two months longer with ovarian cancer, that's actually a reasonably easy clinical study to perform. For sure. An intervention, a screening intervention that potentially, you know, could have a impact that's automatic use greater. Unfortunately, it's a really difficult study to perform. There's no, very little public funding for it. It takes decades to do. There's

no patent protection the way there is with pharma companies. And so, you know, patients, physicians, you know, and the system is left warning for, you know, not just data, but preventative interventions. That's part of the reason why there are only three or four of those tests that you, that you recommend. It's not just because there are only three or four interventions that probably are effective. It's because it's really, really hard, expensive. It takes a long time to study them. Yeah.

Don't you think it's a good thing that it's that hard to study them? Because we're recommending them so broadly to people who are currently not sick. So if we can cause those people harm, that's the most dangerous implication of it all. Because you're taking, like, for example, someone who has cancer, they have a serious problem. So I guess you're more tolerant of side effects when there's a bigger problem versus when you have someone who's asymptomatic and healthy. I mean, I don't think there's been any, that meta study that you mentioned of 12 whole body cohorts. There's a German study on this. I don't think there's any evidence that the consumers considered themselves harm by,

these screenings. There's a difference between a consumer feeling that they were harmed versus where they were actually harmed. And I think the burden should fall when you're testing healthy people to prove that it causes benefit, rather to prove that it causes harm. No, I mean, I would argue that we live in a world, we live at a moment in time right now where consumers are, patients are dissatisfied with the healthcare system. For sure.

We survey patients, for example, that come to us, their level of health anxiety, 30.8% are already anxious about the state of their health, and the health system is not providing with answers. One in every four patients come to us have indeterminate symptoms that they've had for a period of time and have not been resolved by the healthcare system. We survey patients 12 months after the scan. less than 1% consider that we made them feel unnecessarily anxious about their health and regretted the scan.

So we are actually in the business of curing health anxiety that our system has created. We're not in the business of creating it. Isn't that pre-selecting a population that wants what you have and then you're asking them if they're happy with the thing that you're giving them what they want? Because I have patients that come to see me that, for example, ask for opioid medications. I'm not comparing the two, but just in terms of, the consumerization of health care. Patients come in asking for antibiotics for viral symptoms,

maybe a more benign example. And I say, well, I don't think this is beneficial for you. I don't think you need this. I think this will cause harm. But if I give it to them, they'll all say they felt better. Sure. I think there's a, I think there's an assumption, and maybe this is assumption I even had at the outset,

but it's turned out to be like not true, which is the patients that are coming in for these procedures are worried well. And, you know, again, we spend a lot of time surveying and understanding our patients because you understand, you know, how we can do a better job of what we do. Of course, yeah. And they, our patients largely fall into three categories that are about the same size. The first are people that want to take a proactive approach to their health. Now, that includes all those people that are vocal about longevity, pretty much all of them get scans. But there are a lot of other quite normal people that for them, preventative health and proactive medicine is just an important

part of how they want to practice their life, the same way that they might want to eat organic food or do exercise. And not all the other non-medical intervention they do have, you know, 30-year or causes mortality studies behind their effectiveness. Just like organic food. There is no evidence that organic food does anything different than regular food. The second category are people that have had cancer and or have a strong family history of cancer and disease. And many of those in many healthcare systems, they're given an all clear, they're given a pat on the back, and no one ever looks them ever again. And they carry a lot of anxiety about, you know, suffering the same fate as a close relative or having a cancer reappear. And for them not being screened is creating

them a tremendous amount of anxiety. It's negatively affecting the quality of their life, which is a thing that we should be measuring. And they come to us to get peace of mind. And the third categories one I mentioned, which is folks that, you know, are actually very concerned and afraid about something that they are feeling today, typically in the terminate symptom, because the healthcare system is pretty good at acute, you know, resolving acute problems. And they're not getting resolution. And their mind turns to something often, oftentimes like the worst case. And more often than not, we are able to provide them with tremendous peace mind that that symptom that they're feeling is IBD, not colon cancer, you know, or that

symptom, that headache, that's not a brain tumor. It's a headache. And I think that's, I mean, that's, isn't, isn't that how we should be measuring? I mean, you said, you know, do no harm, but, you know, by not providing these patients with its information, we actually are harming them. Well, I don't, I think that's a little bit of a false dichotomy because it's not you either provide the service or you don't do anything. I think when someone has health anxiety in my office, which is pretty much all the time, symptom or not, they are worried about their health, especially these days where there's so many things flagging for them. And in general, people's mental health is not at a great place in the United States. At the very least, I can speak to that, especially

within my patient population. My solution isn't, let me get to the resolution imaging-wise. but it or nothing it's i could do that or i could also approach it from a mental health standpoint in order to treat someone's anxiety treating someone's anxiety with imaging isn't the only way to treat it isn't that fair to say no i would i would say look you're you're no doubt an exceptional physician too and not all physicians are dr mike well i appreciate that um and so you know I'm afraid not necessarily all of them are getting that same level of care. And there's plenty of studies, for example, showing, you know, the fact that on average women have health symptoms that are ignored by physicians, they generally live in a worse state

of health. They're not served as well. Yeah. And that's, I mean, there's plenty studies showing that. and do I think you, Dr. Mike, you know, providing a worse level of medical care to your female patients? No, but when we talk about the system, you know, there are, they're talking about it more broadly. The system is not, you know, is letting people down.

Yeah, for sure. I'm just talking about how do we address it. They come to us to help them get resolution. And many times, not always, we're able to provide that resolution a lot faster and get them to, you know, a state of knowledge about what's going on so they can then focus on treatment and improving their outcomes. Don't you think, because part of what I do when I see a patient, and you may say this is because I'm a good physician or I'm doing something above and beyond, but I've just

kind of learned to do this on the regular because it explains how we think about health care as doctors, knowing how much we don't know. And I think humility and medicine has been missing for some time, and we need to sort of be more transparent about that. So when patients come in and they want an all clear, I agree. explain to them that that's impossible right away. So I set the parameters. So by giving someone a scan and telling them you're good, isn't that also kind of a false promise? No, I think peace of mind, I mean, it's not fair to say that peace of mind is an absolute thing. I mean, I don't walk

around, I don't go about my life holding any real fear that I'm going to get struck by lightning. But my chance of getting strapped by lighting are not zero. Sure. Okay. So I don't, you know, people that do these exams, they understand that they're given it all clear. It doesn't mean that, you know, this is a guarantee. It doesn't mean that they shouldn't do standard of care screening. In fact, we encourage all patients to continue to see their primary care physicians and do whatever

standard of care screening is recommended. But it can give them a greater peace of mind. And again, that great case mind is relative, of no absolute. Fair. Why do you think the organizations like the American College of Preventive Medicine, the American College of Radiology, who would sense a profit from like a whole body imaging approach, why do they say that they don't recommend it right now?

Why are there no major United States organizations that are recommending this? Well, you have to double click a little bit on what they're saying. They're not saying they don't recommend. it because the evidence evidence points against it. They're saying they don't recommend it because they don't yet have enough evidence. So they have not yet got that 20 or 30 year

you know, study testing the reduction or cause of mortality. And that's true. So you're saying the science are not yet proving. So I'm a little bit, what frustrates me a little bit is sometimes those

opinions are repeated in the consumer media. And though too much weight is given to that, you know, people don't really understand how to pass that as a, you know, we can't, you know, disprove the null hypothesis. It's not, you know, this is a scientific statement that is essentially saying we need more evidence. And unfortunately, the way that can, what makes me a bit sad is I believe that can be interpreted by the average consumer. as being there is no evidence that you know it is not recommended because the evidence says this is bad and that's not true right but the lack of evidence again has to be on the fact that it's proven versus saying we've disproved it the vast majority of health interventions that physicians practice

every day do not have all causes mortality clinical trials behind them like what for example I mean, we just mentioned it. Like, the vast majority of primary care practitioners would make recommendations about diet, for example, or exercise that are not supported by, you know, long-dictional clinical studies. Like, for example, if we lower someone's blood pressure from stage two hypertension to a normal range,

from population studies, we can say the decreases. I mean, that's one intervention. There are a lot of interventions that are, there's a lot of medicine we practice. We practice because that's the way we've always practiced. it. Sure. Yeah. That's fair to say. And I feel like we also have something called medical inertia, which is a shitty part of healthcare, where we carry over things that have been disproven, and it takes a while to filter them out. And another way to put that, though, is it's a status quo

bias. Yeah, that's medical inertia. That's a good way to describe it. You know, and you could, one could hypothesize that I'm a visitor from another planet, and on my planet, we screen everyone. And you come, you know, I take you back to my plan and say, well, let me propose you that you don't screen anyone, you know, and, you know, my population would laugh you off the planet. You know, so where you come from, that status quo is really important, and that status quo does not have clinical evidence behind it at all. What we do know is that we're diagnosing cancer and disease late of a, you know, in our $5 trillion healthcare system, about 4.9 trillion is spent on managing chronic disease, the signs of which we can see 10 or 20 years before. And perhaps if

we were diagnosing it a lot earlier before it met that clinical definition, we could change outcomes more easily for patients. So, so, you know, I just, I think that that status, unfortunately, you know, to prove my intervention is, you know, our intervention is the promising one, or your one, which is do nothing, is the right one. Either way, you know, you or I are going to need a 30-year clinical study. So then the question becomes, for someone like myself who's in my 40s, what I do in the meantime? What do I do while I wait for that 30-year study? You know, and the establish would have you say, well, you should just stick with a status quo. And I guess my challenge would be there's no evidence behind the status quo either. Ontario, the wait is over. The gold

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for the gold at Golden Nugget Online Casino. Gambling problem call connects Ontario 1866-531-2-600-0-19 and over, physically present in Ontario. Eligibility restrictions apply. See Golden Nuggettcasino.com for details. Please play responsibly. So I don't think it's fair to say that it's either do this or do nothing. Yeah. I think we should be thinking about prevention and screening where we find the biggest benefit

from research and be really careful about not overdoing it. Because even when I order blood tests, I can overdo it and make it sound like to the patient that I'm checking everything, but knowing that tests have sensitivities and specificities where I might catch things that might end up fueling more anxiety, fueling more testing that is unnecessary, I don't do those tests. And we have campaigns that have elucidated this. They're called the Choosing Wisely campaign. When I was a resident, it was big on not ordering certain blood tests over a certain number of years because they don't change.

And if they do, it doesn't help. And like even the Choosing Wisely campaign in Canada talked about whole body MRIs kind of in the same way. So I'm trying to figure out a way that we can strike the right balance because I don't think the balance needs to be between never screen because I think that's short-sighted and screen everybody because it feels like then we're going to create a problem. And in medicine, it's a unique space, and I'm really passionate about it in the sense that perfect is the enemy of good in health care. When you try and get something perfect, things become bad. So like you try and get good, which is not perfect, but it oftentimes is better. Do you see kind of my...

Yeah, maybe we could talk about it in the context of like one thing that we've been seeing. I kind of curious to any thoughts on this. So when we opened, so our first clinic was in Canada, and the average age of the patient that we're seeing was 52. And when we opened our second clinic in Silicon Valley, we started all of a sudden seeing people in their 20s and 30s. Now fast forward sort of five years now, we've screened over 100,000 patients. And I have a big AI team.

And this big AI team is, you know, obviously building models to figure out. out what a normative aging curve looks like for a particular organ or body system. So that's pretty easy to understand, for example, in the context of the brain, where, you know, we start to look at brain volume or cortical thickness or profusion and things like this. And yeah, they were doing, you know, they've got one of these models for the spine. And the way you sort of expect these models to look like, it's sort of like a graph with a line that goes up and to the right. You know, the older your biological age, the older the AI model, like the older, the predicted age that the model spits out.

Does that make sense? Yeah. And we don't tell these models what features to look at. We just say, here's a whole bunch of spines, try and figure out what patterns are, you know, what features are correlated with age here. And then we can take that model once it's been trained and we can look at anyone's spine and sort of like create a forecast. And maybe the idea was, can we tell someone like how your spine is.

looking relative to this normative curve. Are you doing better or worse than someone over your age? Now, we built this model of the spine, and when we first built it, we're like, oh, there must be some problem in the way we trained it, because it wasn't a curve up until the right. It had a kink at the bottom. It sort of flattened down. And what that meant was that it didn't matter whether you're like the average 20-year-old,

30-year-old or 40-year-old, everyone's spine looked like a 40-year-old. And then we went back to our radiologist, and we said, okay, we started showing them some spines from these clinics where we're starting to get younger patients. And those spines, you know, we said, well, how old do you think this patient? And they were always say 10 or 20, 10, 15, sometimes 20 years older than the actual biological age of that person. So we surmised and we obviously take medical history

and we ask people how much time they spend sanitary and these sorts of things. and, you know, what we started to learn was for people that younger people like grew up spending a lot more time front of computers and phones and so on, particularly in the cervical spine, which is where a lot of these features were being identified by the model, you know, their spines had abnormal degeneration. They were asymptomatic, okay? They may not be ever symptomatic or they might be in debilitating pain in their 50s and 60s.

And what we do know is that longevity is pretty. mobility or lack thereof is, you know, not a great thing for longevity. So the question is, like, what do you do with that information? Because that's a great thing. Like, should I be telling someone in their 25s that they look like their have a spine has degenerated more than it should have? It may mean nothing. You may live a perfectly healthy life.

You may have a congenitally wide spinal canal. So even those dispelages will never cause you symptoms. But maybe you want to know about it so you can do something about it in your lifestyle or not. And that's the question. And I asked myself that same question with blood tests. Because as a consumer, I found it so strange that, like, I have normal cholesterol until it's abnormal. Maybe there's some information that's interesting in the trajectory of my cholesterol levels before it becomes abnormal. Does that make sense?

Absolutely. So I help me understand that. So, and I'm really happy that you're asking me this question because I'm so passionate about this. So you have this really complex AI model that it's looking at all these spines, making its own decisions about what the age of the spine is based on the degeneration, and you're finding this pattern

that's elucidated from people who are sedentary, and it matches the fact that their spines appear older because of their activity level. I'm an old school doctor, I guess old soul in some regard. I would find that out by talking to the person and asking them what their lifestyles like. And if they're sedentary, I'll tell them that it's a risk. Yeah.

And what changed from getting the skin? No, and I think that's fair enough. But the question is... So like, it would need to change what I would do. And if it's not changing what I do, to me it functions as a distraction from the actual doctor-patient thing. So what was the second part of the question that you said for blood tests? What can you do with cholesterol?

I think that's amazing. And the problem is it's easy these days, especially, you know, being near San Francisco with people who have tremendous amount of valuable resources, excitement that want to preserve life, want to be as healthy as they can into old age, to catch these things early. But the problem is it's never that simple because any time you think you've caught something early, whatever impact you're going to make there will play some sort of reflexive opposite in the human body. So the human body is so tricky in treating

that every time you think you solved one problem, you've created another. And that's why, like, I would love to say, screen more for everything. I'll give you a very specific example. There's a fashion show in New York City for Men's Fashion Week, and I forgot what the pharma company is,

but they run something called a blue jacket fashion show. And I've walked in it several years, a lot of, like, Yankees, players, local celebrities from New York, walk in it. And at the end, they had everyone walk up to the microphone and say, get tested, your PSA to check for prostate cancer, because it's a prostate cancer show for the Prostate Cancer Foundation. When they came up to me with the microphone, I was like, talk to your doctor about

whether or not prostate cancer testing is right for you. Because I think that universal screening for everything can truly create more problems. And we've seen that with PSA testing, as you've mentioned. We've walked back breast cancer imaging to some degree because we saw the negative of repercussions. So to say more screening is always better than some, I feel like is not true. Do you agree? Yeah, I don't want to be argumenting, but I would say like the, I don't think you can say that the opposite is true either in the sense that. It's not true. I agree. When I, when I learn about my issues with my cervical spine, I'm asymptomatic. Okay, but I had a sedentary lifestyle. and my first company was a mobile phone company.

So I spent a lot of time with mobile phones, you could argue. I went for my annual checkups routinely. Doctors asked me a very cursory number of questions in a very, very short period of time and not a single person told me that I need to watch out for my spine. And I would say, I would argue that the vast majority of people

for which we provide these sort of like lifestyle suggestions, I don't want to call them medical diagnosis because, again, they don't meet the clinical definition of disease. Sure. The vast majority of people that we provide those sort of, like, tips to, for them, that's a surprising insight. So the health system, unfortunately, again, I come back to maybe not everyone is like Dr. Mike.

That's not a reflection. What you described, I don't think, is a reflection of the average quality of care in a health care system, which is overtaxed. What is? That, you know, that, you know, that you're able in a standard five-minute consult to elucidate the impact of lifestyle on someone's potential underlying health. So I don't think it needs to be like a dense discussion. I think as simple as what do you do for a living, I do this. Do you exercise? Not really. Well, if I tell you to exercise, I know that I'm proving so many variables all at one go, including your spied. So while I may not focus on spinal health, the purpose is the same.

I bring this up because I've seen this with companies that offer, let's say, like microbiome testing or gut testing. I know that's not something that you're involved in, but the companies do offer that. And when I've seen patients bring in the data and they have some complex gut microbiome profile that I don't even understand, it's kind of above my understanding of it. But the recommendations don't change from the recommendation. No, I get it. But can I just, I mean, by the way, this is the thing I spent so much my time thinking about,

particularly more recently, is like the psychology behind good health. Oh, okay. Cool. Yeah, I love that. And, you know, I lived in Europe for a period of time. And, you know, on a cigarette packet in the U.S., there's a big message that says smoking kills. Yep. In Europe, there's a message that says, you know, something similar, smoking kills, or smoking

Smoking does this to your lungs and it has a big, disgusting picture of the lungs. Yep. So you might ask the question, you know, why would they do that? And, you know, I would argue, because I presume they're smart people, these public health folks, that a picture is a more visceral catalyst of change than, you know, just words. And what we find when we image people that have, that are actual smokers, and we can show them a picture of, their own lungs and the chronic inflammation caused by smoking, you know, there is no greater catalyst for them giving up than seeing a picture of their own lungs. So it is true. A lot of

these lifestyle recommendations to many people, including us, including the average picture, are kind of obvious. We might find, let's say, small vessel ischemia in a patient for which, you know, making sure they're in good metabolic health probably is the most important. important thing. Now, you might argue, well, that's kind of obvious. Like, I provide that recommendation every day anyhow, right? But patients aren't necessarily listening. And that those psychological barriers are real. And they stand between us and having a healthier generation of Americans. And I wouldn't discount the catalytic power of showing someone what's going on inside their body.

The same way when I got my car checked and they gave me a 30-page report, you know, it was powerful to be able to see the sump that was leaking oil and knowing that there's a real thing going on there and there's something I can do about it. Yeah. Yeah.

The car thing is a tricky analogy for me because cars don't heal themselves. Cars don't have problems that are there that then resolve. Like if your tire is worn, it's worn, it's not going to... Well, I think it's a great analogy, Because if my car completely breaks down on the side of the road, I can go buy a new one. If my body breaks down, I only got one. Right.

So if I scan people who are asymptomatic spines with MRI and find that they have some arthritic changes and they have no symptoms, am I going to recommend that they get surgery? Am I going to recommend any intervention? I found a finding. I don't think you should. I mean, I think in America, there's no other country in the world that does more spine surgery than America. So I think that's absolutely the wrong outcome. So that's the question. Like more data. But you know what? Our most common

recommendation when we see that, core strength. Now you might again, it's a fair argument to say you should have you work on your cost. So you say this as a motivational tool? Why? I mean, I think the role of primary care when you're armed with this type of information becomes much more sort of practitioner coach than it does practitioner diagnostician. And I think that's where, you know, and I think there's tremendous value unlock in that world. What happens to an individual when they, let's say, get a scan and you say you don't make a diagnosis, you say your level of concern? We do make diagnosis of certain things. We diagnose fatty liver. We diagnose the scheming changes. But for cancer, you'll-

We diagnose degenerative spine conditions. I mean, there's certain conditions for which MRI is called standard, and there are others for which you need a confirmatory test. Got it. So in those instances where it's not a diagnosis, it's a concern level. Ultimately, it falls on our health care system to then figure that out. Yeah. I mean, oftentimes, you know, if we see a very concerning lesion, oftentimes we might recommend a patient go get a contrast exam. Contrast CT or a contrast MRI.

Look for vascularity around that lesion. If that, you know, self-concerning, then, you know, depending on the organs, sometimes they might go straight to surgery or biopsy. And that's typical clinical clinical care pathway. If there's a range, you said one through five, that you give a level of concern for these things, patients can, if they have a level one to end up going to their primary care doctor like myself or maybe to an oncologist or something more advanced and requesting appointments, times more imaging, even though you labeled it lower risk.

But because they have something there, they would go into the health. health care system to do that. I mean, we do our best and we do more than the average radiology practice in counseling and recommending a course of action or inaction to the patients. And oftentimes the right course of action for something that is benign or even something that's in the terminal but quite small is to just follow this on a subsequent scan. So there is also an additional tool that's available to us that is not available. in the, typically in the reactive care healthcare system is we don't have to chase everything to the end of the earth. We can follow it on a subsequent scan. And, you know, if there is no change,

then that favors a benign process. So a lot of our patients, you know, that's our recommendation. That's what they follow. Can a patient overreact? Of course, can a patient overreact in any clinical context? Yes. So you think the concern of overdiagnosis and false positives is an overblown concern in general and that there's just so much benefit from the scans. Well, I would argue that, I mean, if, I mean, there are thousands of practitioners that are referring us patients every year. And so if they felt like that it was not, and they don't get anything from this. So if they felt like it was not in the benefits of their patients, they wouldn't do it. If they felt like it created more work for them, they wouldn't do it. So these are all

practitioners that have, you know, come to value the insights that the company is able to provide and as a result continue to refer their patients for these scans. I meant from like your point of view if you feel they're overblown. Well, my point of view doesn't really matter. I'm not a physician. That's your company. The point what I mean, I mean, obviously I wouldn't be building this if I had a point of view that those concerns were not overblown. I do think they're overblown. But I think the more important opinion are the opinion of primary care providers. And I mean, I think it's kind of interesting that whenever we see someone speak about these scans publicly, one of the first things I have instructed my teams to do is to reach out to them and invite them in

to understand what it is that we actually do. And there has not been a single physician who has spoken out about these scans that has firsthand knowledge of the scans themselves. What do you think their misunderstanding is? I think it's, I think, twofold. You know, the first is screening has been tarnished by the sort of proliferation 20 or 30 years ago of whole body CT screening in shopping malls around America. I remember the Oprah episode. Correct. And you seem too young for that, but you're very good.

skin. And, you know, and people have long memories. And people who don't fully understand the difference between CT screen and MRI screen. As plain doctors have gone on record saying they don't like what we do at Prenuvo because of radiation. And we all know that like MRIs don't even have radiation. Could they be talking about the follow-up CT scans that might be necessary after the MRI? I mean, they could be, but they're not. Well, that's hard to say. It could be, Well, they're talking about for new, so they're not talking about the follow-up care. I mean, they don't clarify by saying that, you know, that there might be some follow-up tests that involve variation.

And then the second thing, and this is really important and also a bit misunderstood, unlike CT, or I say like most misappreciated is that MRI is a qualitative imaging modality. what does that mean for the lay person i mean think of an MRI as taking photos of the inside of your body i have like an iphone what's the latest generation 16 i got a 16 pro takes great pictures of my young daughter my nuky phone in the 90s also took photos they were horrible okay now why is my iPhone taking better photos it's a combination of the hardware you know the lenses and the things that sort of capture the light. It's a combination of the software

that that sort of processes that. In MRI context, that's the protocols that we run, the beeps that you hear when you're inside the machine. And increasingly AI. And we have AI running inside our machines as well to undersample and up resolve images. This is a 30-year-old technology. It has come tremendously far in 30 years.

And if I'm a busy primary care provider, I don't really have, I mean, it's hard to keep up to date on how these fields have evolved. That sequence I mentioned, diffusion sequencing imaging that measures hardness inside the body. That's really only been in clinical practice for like five or six years, maybe 10 years max. So if you went to medical school, you know, 20 years ago, you may not really be up to date on how these things have sort of evolved. And that's part of the reason why we do a lot of outreach. And we work to do a lot of education of physicians. And it's fair to say, Dr. Mike, that probably 80% of physicians that we reach out to are initially skeptical.

But the ones that come in and understand it firsthand, more than 80% of them refer us patients thereafter. So there's a real information asymmetry. And the asymmetry is about the technology. about the technology and the quality of the imaging today. Because to me, the criticism that we're talking about from some of these groups choosing wisely ACR is less about the technology and more so about the human body and the disease process and what we do with the information.

Well, but just to double click on the technology, for example, you mentioned that meta study of 12, I mean, part of the problem was every single one of those whole body studies use different hardware and different protocols. Sure. There was, I mean, a lot of the insights that we've gleaned from whole body imaging come from the UK Biobank study where they actually did a whole body exam on some subset of those patients, of those participants.

And they were using what's called a Dixon technique. Now, to give you a sense, our exam is 45 minutes long. The Dixon component of our exam, one and a half minutes. So, you know, if I thought I could do a high quality, diagnostic quality, whole body MRI exam, one and a half minutes, that would great. But you can't. But that's what a lot of the insights on whole body screening have been built on top of. So the hardware and the protocols, that radiological interpretation really, really, and the AI increasingly really, really matter. So you think they're saying that the technology is not

good enough yet to make these scans worthwhile? Because I don't feel like I've seen that from my colleagues because you mentioned you have thousands of doctors that refer patients to you but on the flip side there are thousands of doctors consensus groups who would say not to send patients to you well they would they would say that they're still waiting for that long-dural evidence in order to form an opinion the same way the USPT what is it had united states preventer service tasks i always get tongue-tied on that one you know i mean they're uh the same reason why it takes 30, 40 years for something to land on that list and then sometimes come off the list and sometimes come back on and sometimes under political pressure

going on the list. So, you know, it's a messy process. But in all cases, it takes a long time. Yeah, like I think about, are you a fan of, like, watches that track sleep and heart rate and all that? I don't have one. Well, I just, I don't know if you were not wearing one now, but you're a fan in general. Are you? I'm curious. I've worn them. I don't continually wear them, you know. You don't find them useful or? I find, you know, I've worn a CGM for a period of time, you know, for two or three months. But I think there are really interesting insights that you can glean from, you know, in the case of CGM, like there are foods that I expected would raise my blood glucose but didn't.

And there are others that I thought wouldn't but did. But once, you know, over time, the level insight goes down, I would say. Yeah. Yeah, I think the, I try and think of myself as open-minded as can be in this tech space because I'm a excited about trying to help my patients as much as I possibly can. But at the same time, trying to be skeptical enough where I'm not just allowing a full open cascade of new tech to bombard my patients and bombard me technically with more information that I know what to do with. And that's my biggest struggle and my hope is that there is more research done on this,

more investment done to figure out who's the right candidate for it, when we should be implementing it, like, you know, using the smoker's example that you gave earlier as a motivational tool, that could be a great case study use for smoking as a screening tool. Like maybe that's a better screening approach than low-dose CT. So, like, that would be really interesting to me because then that would sort of make it targeted and a little bit more actionable, where I would feel comfortable that I'm not sending my patient for a test that could yield them harms, anxiety, further down. stream testing because it is not unreasonable. And I know a lot of people use this as like clickbate

and write articles on it. I'm genuinely not that person. I hate that stuff. I see patients that have some suspicious nodule end up getting some procedure, getting their lung collapsed, end up with a chest tube placed. Chest tube gets infected. They're in the ICU. And I'm just like, holy shit. what it taught me in health care is that ultimate 100% control doesn't exist. And the more I can help my patients become okay with that and do what we do have good evidence for and stick to that, the better I think they will feel ultimately because they will have less anxiety and they'll have better performance. Will I prevent all cases of all preventable cancer, no, I don't, I, I think when I try and do that and exhibit that much level of

control, I think that's when we start hitting that perfect milestone and getting the negative repercussions of it. I'm just curious what you think of my mindset on that. Well, I think I also, I'm challenged, but I'm sort of challenged by this myself because we are sometimes sort of grouped under the category of like longevity interventions or medicine. And I struggle personally being the CEO of a longevity company. Okay. Because I don't, when I see the sort of people that speak about longevity,

I don't see myself in those people. Who are you thinking of when you say that? I don't want to name names, but you probably know what I'm talking about. Interestingly enough, not too long ago, Brian Johnson was sitting in this seat. And he actually posted something recently

about Whole Body MRI, I think with actually one of your competitors. So we won't name them, but. But I just think there's, I mean, longevity in some ways in my in my opinion i mean he's actually doing a lot of good educating folks in some extent but i think more broadly uh it sort of needs a rebranding because you know i am i generally try to leave my life sort of 80 20 um i can't i don't have 10 hours a day

to focus on being healthy i'm running a company i have a young child and a whole lot of stuff so like, what are the... And what does it mean to be 100% of... Right, exactly. Oh, yeah, you know, I do these, you know, spend an hour in an ice bath and, you know, whatever. I think all the stuff is within reason, right? Right. And, but I think that when people think about the longevity movement, I don't know if I'm saying

that right, because I'm Australian, is it longevity or longevity? Longevity, yeah. Longevity. I mean, that's what they think of. That's, you know, those are, they're thinking about all these crazy stuff. They're thinking about Peter Thiel, like injecting, you know, the blood of young people to live longer and stuff like this. And I just think that does a disservice to what I believe we need, which is, you know, try and identify, you know, continue to research and identify a series of interventions that get us a lot further along than where we are today. And you and I might argue about what those interventions are or what might be the evidence to sort of like arrive at where we feel comfortable, sort of like recommending one thing over the other.

But I don't think it's 100 things. But I do think it's more than three things, which is what we have today. And we've got to figure out what those other things are because I think, you know, solving, solving that is a required step in transforming, you know, this reactive health care system. It's something more proactive. Yeah. Summer's here, and you can now get almost anything you need for your sunny days delivered with Uber Eats. What do we mean by almost? Well, you can't get a well-groom lawn delivered, but you can get a chicken parmesan delivered.

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what they're worth too. So your business can stay unfazed. Learn more at SAP.com slash uncertainty. Oh, hi, buddy. Who's the best? You are. I wish I could spend all day with you instead. Uh, Dave,

you're off mute. Hey, happens to the best of us. Enjoy some goldfish cheddar crackers. Goldfish have short memories. Be like goldfish. The white chocolate macadamia cream cold brew from Starbucks is made just the way you like it. Handcrafted cold foam topped with toasted cookie crumble.

It's a sweet summer twist on iced coffee. Your cold brew is ready at Starbucks. Bank more oncours when you switch to a Scotia Bank banking package. Learn more at Scotia Bank. Bank.com slash banking packages. Conditions apply. Scotia Bank. You're richer than you think. I'm also curious from the motivational standpoint, how to get people, because, again, a lot of the research that's done in this space is done with people who are already self-motivated,

which really biases the research because a lot of my patients that come into my office are working three jobs, have multiple children, have life problems, don't have a lot of wealth. I work at a community health center. They're not looking for massive amount of prevention. They're not the Silicon Valley type. So how do I get those people to come in for the free? This isn't even a financial thing. This thing is free.

It's paid by the government, but they don't come in for it. So like, how do we start even there? Because if you think about 95% of age 35 older do not come. It's not three, but the limited amount of preventive care that we do have evidence-based medicine cause for. They don't come in for it. Yeah. That's to me like, if I'm trying to pick up the most way possible, I'm focusing on that boulder. Well, I have a hypothesis that we're sort of testing somewhat in this trial we're running in Boston, you know, because we do have this sort of social equity component to it.

You know, there was a study in the UK a while back where they looked at sort of the average clinical pathway, you know, how, you know, what it took to arrive at a cancer diagnosis. And I sort of, I don't like it that. We keep talking about cancer because I think what we look at is a lot broader than that. But like it's sort of interesting in this UK study, I think it was something like it took on average six months from presenting with symptoms at the GP to a diagnosis. And it took also something like 12 visits to GPs and specialists. To make the diagnosis.

to make the diagnosis. Now, National healthcare system makes it hard. No, don't know. There are more similarities and there are differences between health care around the world,

okay? That's a political, you know, that's just politics. It's the same in the US. Now, if I, you know, if someone presents with,

again, like in the terminate abdominal pain, maybe nothing could be cancer, who is going to arrive at a diagnosis faster? The upper class worker who, can take unlimited sick pay and time off to like chase things out fast or the um or someone who's

working three jobs has two kids no child care and um you know struggles to you know is constantly canceling their doctor's appointments because their kid is sick who's going to arrive at diagnosis faster the person who's more motivated more time so this you know one of my hypotheses is that are potentially a shorter path to diagnosis for the people, like a, you know, potentially an equalizer for the people that need it the most. Because in our healthcare system, what I believe is that, you know, once you're diagnosed, there's no better system in the world than the US healthcare system to like get treated and get resolved. But the biggest disparity is happening in getting to diagnosis. And maybe these scans can actually help.

write some of that disparity, were they more widely available? So that's part of what that study is designed to prove. Or not prove. But I think that's a hypothesis that's worth checking. Yeah, I think that's interesting. My question is, if we go down this hypothetical, how realistic is it that those patients who don't have the time who work these jobs pay $2,500 out of pocket to get the test?

And then what happens treatment was after? Look, it would follow. that that test would have to be provided for them. I'm not suggesting that they would pay out of pocket. But what the clinical study is designed to look at is to see, you know, what is the impact of this testing do on that cohort of patients that otherwise would have access to it?

So there's always still a question of how does it get paid for, who pays for it, is it covered or not? And can they access it? And can they access for sure. But putting that side for a second and what impact does it have, you know, because you're right. I mean, getting some of these folks to come in for one appointment is really difficult. But it's easier to come in for one appointment and it's to come up for 12.

So you're saying the time savings of it all? 100%. You know, maybe they come for those 12, but it takes them three times more time. So, you know, that average in the UK of six months, I mean, it is what it is. It's an average. There were some people that got diagnosed in 20 days, and there was some that took 200 days. Right.

You know? So, but also for those people, again, I try and think of both sides equally. They'll come in for less appointments because they have the one. But then how many more follow-ups do they need because we are scanning everything and there's a higher rate? Well, and let's distinguish between what type of follow-up we're talking about. So there are essentially two types of follow-ups from a prenevus scan.

The first is we diagnose something, and there is follow-up in the course of treating a condition. So, for example, if we find severe fatty liver with fibrosis, there is follow-up 100%. There's follow-up because it's a medical diagnosis. What you're really asking is, like, what follow-up is there that might be required to, you know, confirm or not an indeterminate finding?

And we're studying that. And what we know from clinical experience is it's much less than people think. yeah i would like to see where that yields and uh realizing the fact that a diagnosis was made and there needs to be a follow-up for it is also interesting because again just because we made a diagnosis and there's evidence for it anatomically or cellular on a cellular level doesn't necessarily mean we need to take action but sometimes that is bringing for in some ways um there might be more follow-up today what we're really doing is bringing forward a medical diagnosis that would have happened tomorrow.

At times, or it would have been never found or impacted their life. Yeah, there's lots of hypotheticals. Yeah, that's what I'm saying. It's important to consider the whole picture. I try and be as holistic as possible with this kind of stuff. And I know it's hard to hear it because

it technically speaks against them. It's hard to be declarative, by the way. Yeah. That's the challenge with health. Like you said, I mean, I think you mentioned you made a very good point, which is like our bodies are very complex. Yeah.

complex and our control is limited to some degree. So I'm trying to figure out how we exert control in a valuable way where we're not overdoing it but not underdoing it and finding that balance. And people can very respectfully have a discussion about it where that line falls without any kind of dramatics involved with it because people will have different risk tolerances. Someone will say, oh my God, you go rock climbing.

You're going to fall. The risk is immense. I would never do that. Both are reasonable people. But I think that's where I sort of land, which is to say, okay, absent, you know, conclusive evidence, one way or the other,

a lot of this, you know, until that moment arrives, what we can and should do is inform patients of their potential benefits and their potential risks of these exams. And if they... Well, it's hard to know that

until the research has been done the longitudinal research. I mean, I think we've just spent last hour talking about some of the potential benefits and the potential risk, right? So I think... But potential is kind of a cloudy term here because we don't know what the long-term data would show, right? Well, I think on the benefit side is potential early diagnosis and better outcomes. I think the counterpoint would be potential overdiagnosis and or false positives or treatment or something like this. I think that's, I mean, I don't think you'll ever get more

precise a discussion than that. Yeah. And I think, but that's, it's so important to figure out which way the scale goes, right? Because if you just tell a patient, well, like, look, we could be over testing you, or we could be catching things early. Both are valuable, right?

Like in terms of you want to not overtest and you also want to catch things early. But which way is the bar graph higher, I guess? Are you finding more things early and are intervening and prolonging life? Or are you catching a lot of things prematurely, perhaps over-testing and causing harm? Until that's elucidated. But then, well, maybe I'll finish the sentence for you. Until that's elucidated, do we think it's the practitioner that should be making that decision on behalf of the patient, or do we think that we should do our best to inform the patient

and allow them to make a decision? I think it should be a shared decision-making approach, which is kind of where we land with a lot of these screening protocols. I mean, the PSA is a prime example of something that we used to recommend and now it's in the shared decision-making approach. When a patient approaches me as to whether or not they should get scanned,

it's based on their case. What's going on with them, what their mindset is like, what their family history is like, but it's hard to universally say that everyone should get it. But as a business model, you kind of have to say that.

No, I think that's exactly those thousands of practitioners, is that refer us patients, those are the conversations that they're having with their patients. Yeah, I'm curious if they are, or are they just saying, like, we just see so much benefit in this, we're believers and we're sending all our patients?

Well, I mean, they... I'm curious. I can't speak for them. That's my curiosity, right? You know, Dr. Peter Thier talks about this, and he talks about informing patients, and he is very, you know, he has a, he has a, you know, a monologue.

about the benefits and, you know, and the types of patients that could benefit from or not benefit from whole body screening. So I think. I also think he has a partial ownership of an MRI group for this. Oh, I'm not aware of that. Yeah. So like, again, very complex. Yeah, exactly. I think he talked about it on one of his shows. But it's, it's, it makes it a little bit muddy. And I'll tell you one thing, like out of this. Well, none of those thousands of practitioners that refer us patients have any ownership. Yeah, exactly. Yeah. I'll tell you the one thing that, like, if I'm to be the most skeptical and cynical of of the entire process, is one thing, and I'm curious how it lands for you being in charge of it.

When I see a celebrity make a statement that this test saved my life, when Kim Kardashian very popularly posted for you guys, when Kim Kardashian makes a statement in the health care space, from my experience with my patients, it is a thousand X. more influential than when an academic journal publishes something meaningful. So it's concerning to me when that type of celebrity advice, which is very case study, very influencer-driven, is guiding my patient's decisions. And I worry about that.

Do you ever worry about that? I mean, personally, I see the benefit of some of those folks speaking out in just raising awareness that these technology exists. And I think it's appropriate, I mean, when someone learns about this, to speak to their primary care provider to understand whether it works for them. If a patient doesn't have a primary care, so if someone comes to us that's not referred, we have a process. We work with medical practitioners that do an appropriate review for every patient to understand whether there are any contraindications, to understand the reasons why they want to get the scan. What would be a contraindication? For example, pacemakers or

Metallic stuff. Neurotransmitters, things like, yeah, exactly. Typically implants. Got it. Metal in the eye, things like this. They, we ask all of our patients why they want to come in for a scan. And part of that premise review is to understand if we are the appropriate test for the reasons that they want to be screened.

What would be a reason that they would say something on that answer that you would turn them down? For example, if someone's primary concern are I have constant splitting migraines and I want to figure out what's going on, we would probably recommend that they go get a dedicated head in my mind. And we don't do those. But I remember you said earlier in the conversation, there's a lot of people who have non-specific symptoms

that find diagnosis as the third group of people. For sure. And that's not, I mean, I think there's, it's a gradient. Now, sometimes people have symptoms and they're also looking for a holistic health checkup. So every one of these is evaluated on a case-by-case basis. And I think I don't know what the percentage are, but a certain percentage of folks are referred or sent

or suggested that we are not the right test for them, they should go get something else. Got it. An example might be patients that have had cancer within the last few years. We don't often consider ourselves to be an appropriate test or we will not perform that test without having a primary care provider actually write us a referral.

because we do not want to substitute for whatever might be the treatment plan or care that their oncologist is sort of like directing. So we do have, I mean, it's a clinical practice, our radiologists have, you know, every time they sign a report, their license is online. So, you know, they are trying to be very careful about, you know, what makes for, you know, as we start to think about what are the criteria is a medical approach for the exams. Yeah. How often from that standpoint do you think about, because you said you're very interested

in the psychology of health and wellness, like I know the way that I speak to a patient about their condition, I can make them exponentially more worried about the condition or less worried depending on the language that I use. You're familiar with that, like I guess logic? So if I tell my patient, oh, this is a very scary condition that could end up with this symptom it could metastasize whatever like i could use words that would make it sound scarier to a patient when someone of social influence says this thing saved my life i see my patients get very worried about their own health and it fuels their anxiety as if they're not doing something or we're not

offering them something as if they're being let down by us yeah that's my struggle with the celebrity influencer of it all and then like i'm I'm pretty sure you guys don't pay people for advertisement, but you give them free testing. We sometimes do, yeah. Because like disclosures and all that, how do you handle that? I mean, we comply with whatever are the laws. I mean, we operate in different jurisdictions. So, I mean, I'm not actually have a law degree that I don't use anymore, but I'm not the lawyer.

So, you know, I have a team that makes sure that we sort of typically appropriately inform. Well, I'm curious, did Kim Kardashian came in as just a regular patient? So she paid for the test? And Paris Hilton, all these celebrities, they're paying for their tests out of pocket? I mean, I don't run it, so I'm not sure who paid and who didn't pay,

but like many people come in and pay and don't talk about it. They have big audiences. There are folks that come in and pay themselves and they want to talk about it because it had a profound impact of them or their friends. And then the reverse is true. There are folks that, I mean, we don't tell people what to write about us.

There are folks that we think it would be interesting to educate them on what we're doing. Some of them might be physicians or non-physicians. And sometimes the most likely outcome is they don't ever say anything about us at all. Yeah, the reason I'm just such a skeptic is being in the business and seeing the influencers, like I know what Kim Kardashian charges, one to two million dollars a post. So to see Kim Kardashian make a post, say not an ad, that's worth $2 million. I mean, you guys aren't UNICEF, right? Like a nonprofit company.

You're a for-profit company, and she's giving you guys $2 million worth of advertising. It's just strange. Like, why is that happening so often with celebrities? I mean, I'm sorry to say, again, and I don't want you to take this personally, Dr. Mike, but I think it generally reflects a disillusionment with the medical system in general. and that people feel like they are you know the system is not working for them so you think a person like kim kardashian doesn't have a system that works for her no i think she understands the context of the american health system and she has a tremendous audience and if she feels like sharing the

news of this you know this exam with her audience can potentially change outcomes for those people why not do it interesting well because i would love to see it be done to get 95% of people who are going for their preventive streets. I mean, I wish I, I don't unfortunately have her in my phone, but I'd be happy to connect you with some of these folks. I mean, I think that's 100%. You know, I do a lot of podcasts and, you know, I, it's a rare podcast that I don't say, do your colonoscopies, do, you know, do your mammograms, do whatever is a stand of care testing. It's really important. I'm curious as my last question to you. For you, you were living this quote unquote less than healthy lifestyle because you were founding company serial entrepreneur

and then you had that test done in Canada. What lifestyle changes did you make after getting the test done? A couple. I would say the most profound one for me was, I mean the worst findings I have with my spine and the most profound change I made is I now work at a walking treadmill desk and I walk about 10 miles a day when I'm at home and it works for me you know it's I my I stand a lot straighter now my posture is great I mean I never used to be out even to stand on two feet

but like you know that's awesome stand up you know without sort of wanting to shift my way into one foot for you know you know after more than a couple minutes now I can stand on both feet for like an hour and so it's been really really helpful it's a small thing yeah you know and it's a for me it's an intervention that I can do

without changing your world my work and still be busy yeah I do have to tell people when I'm on a call that I'm walking on a treadmill because I have a lot of breath and then I have at my workstation I've been experimenting with one of those like pressure plate at the vibration plate things oh cool which for which I think there is way less signs but I thought you know someone gave me one but super benign so I thought I would try it and now I have to tell people that I'm on one of these scenes because I think I'm just cold okay makes sense so you said walking was one and the what you said you two I mean I've just I would say

I just got more conscious about my diet and I do I now I'm down to two meals a day oftentimes one meal a day I don't do breakfast anymore and this was mainly not because anything was particularly diagnosed but you know I I've got very great abdominal muscles from having sucked in my stomach for many years and the great thing about MRIs you can suck it in as much as you want. You can still see it there on the image. And, and, you know, what I noticed in myself, and I mean, this is well studied as well, is that men, you know, before I think their mid-40s tend to carry their weight subcutaneously. And then once you hit mid-40s, you start to bring it, it somehow comes inside and it's visceral. And I see that on my scans.

And that for me was just a big kick in the backside to, you know, to, um, to, um, you know, practice, you know, going 14, 16 hours without eating, you know, as many days as I can. Yeah. And that's a great strategy for some people, especially some people wake up without a huge appetite in the mornings. I think it's really reasonable because people argue with these different camps, oh, I am intermittent fasting, I'm keto, I'm this, I'm like, look, whatever gets you to consume less and you could stick to it and you're not overconsuming some harmful ultra-process food's great. But I grew up with breakfast being the most important middle of the day. Yeah. And I think that's probably one of the biggest lies that have been told to us forever.

Yeah. I look back at the history of medical mistakes and realize we have to have a lot more humility of saying what we don't know. Because when we come with utmost certainty, I feel like that's where we run into problems. That's why I'm always so skeptical and trying to see both sides to try and do my best to not repeat the mistakes of the past. Yeah, no, I think it's great the work you're doing. And, um, and, uh, you know, I'm just excited. Hopefully from the conversation, you can tell, I mean, we take it really seriously. We're, we're at clinical practice. We're trying to, you know, we're also a startup business as five years old. And I invent, I, I, we reinvest as a business, everything that we make from these scans in furthering the technology

and in doing research. Yeah. And I'm really proud of that as a company and as is our clinical team. And while we work to establish, you know, that sort of, you know, the evidence, the all causes, mortality study, I mean, we just can't sit on our backside and do nothing for the next 30 years. So we're running, you know, we're looking very carefully at the objections that people are making around anxiety or around downstream testing or around sensitivity and specificity and things like this. And we're designing clinical studies to see if we can. address each of these objections and sort of build in the meantime something of a, you know, a more solid circumstantial case.

Does that make sense? Yeah, yeah. And bring a little bit more data to a discussion that is a bit absent of data or has historically been absent of data on both sides. For sure. Yeah. I also see, maybe you can't answer this because you can't speak for other companies. I know there's other, obviously, people doing similar work.

and obviously everyone has their own technology, different software, et cetera. Yeah. Does the major organizations ever reach out and say we'd like to participate in that research, be a part of the research? You say it's hard to patent screenings. Is that something that you guys have patented?

Is that possible for the NIH, for example, to come in and say, we'd love to use our technology? Are you open to that? I mean, a lot of people watch this channel. I mean, we had the vice president of three years before the election. I would love to talk about it. I would love to find a way to accelerate the evidence gathering. The real challenge is, think about like mammogram.

That was, you know, adopted after clinical studies covering something like two to three million people, I think. I mean, there was a lot of evidence gathering that took place. And internationally. Yeah. And so we, I mean, we perform a scan that costs, you know, $2,500. So if we wanted to do a standard clinical, clinical trial with 2,000, 2 million people, I should say, at $2,500, that would consume the entire

budget of the NIH. Well, the cost hopefully goes down when you're at 2 million people. Not as much as you would think, because the biggest cost here is radiology. Well, maybe with AI in the future. Yeah, I mean, I think that's one of the areas that, again, one of the areas we reinvest in is looking for ways in which AI can speed up the scan, can help. make, you know, help radiologists be more productive and so, and deliver insights to clinicians that, you know, are difficult for radiologists to do because maybe they're small, subtle

changes over time. So yeah, it's a big part of it. But yeah, there's a lot of, you know, it require a lot to run a study of two million people. Sure. And, uh, and I'm not sure that I would love to, I would hope that new NIH if it's still around. It will be sort of funding that sort of study. Um, but absent that, um, we do what we can in clinical studies. that we run. And we are collecting evidence in the ordinary course of building out a clinical practice and, you know, running studies and then hopefully bringing those results to people like yourself so that, you know, every year that decision that you're making to recommend or not recommend these scans can become a little bit more informed. Do you, because, you know,

we talked about the American College of Radiology, are you facing that same criticism, potentially doubt from other nations' health care systems? I know the British Medical Journal has written a little bit about overdiagnosis, but what about abroad? Or are you primarily United States? I can't really speak very smartly about this. I mean, I understand that there are some countries like Japan or Korea where image-based screening is a lot more prevalent and common.

I know that there are countries in the Middle East that are looking to do population-level studies around this. So there's a, like, willingness to really lean in, I guess. I think most of the developed countries are sort of consume, you know, the Western developed countries are a bit consumed by the, just how overworked. And, you know, just all of the other more pressing problems that are presented by this reactive healthcare system to have sort of the mental bandwidth to even think about doing things differently.

Got it. Yeah. Well, look, I appreciate your openness. transparency and excitement for having this conversation, I get really nerdy about all the science of it. So thank you for your time. And thank you for the work that you're doing and trying to create more research in this space where we desperately desperately need it. Thank you, Dr. Mike. Appreciate it. Cheers. All right. Let's leave you with my final thoughts after this conversation. First of all, a big thank you to Andrew for coming on to discuss the topic and allowing me to state

my concerns openly and have a civilized discussion. I have to say I'm certainly intrigued by the technology and am in love with the concept of catching diseases earlier so that we can have more success with treatment. However, I am still not sold that this is what the Pernuvo scan has proven to deliver. In the day and age where we find ourselves, folks want more out of health care than we can yet deliver. I'm not surprised that thousands of doctors are referring to Pernuvo, given the pressures that I know doctors face to be up to date with the most groundbreaking tech and the rise of consumerization in this world. Patients, especially wealthy ones, often come with a list of demands

and that consumer pressure can impact the doctor's decisions, especially when the harms of that decision aren't well established and the benefits sound potentially revolutionary. Unfortunately, if we're being brutally honest, the term revolutionary in this regard really just means unproven.

And when it comes to unproven interventions in health care, I am wary. Barring emergencies, if I don't have clear data for the harms and benefits of an intervention, especially one that is meant to be used on healthy people, I cannot widely recommend it.

Offering a test that can catch so many diseases early while our Stone Age healthcare system falters behind sounds like a great deal until you have to wrestle with the complexities of how the human body works and understand how simple statements like we caught cancers early can be highly influential and deceptive,

even if not done intentionally. On a positive note, I am confident that we will create new prevention and screening guidelines in the near future. There will be new technologies paving the way here, perhaps per newvo can be a part of that, especially with AI improvements that can help narrow which patients would actually benefit from a scan. But at this time, for me, these whole body scan programs are more of a mix of health curiosity and clinical experimentation as opposed to proven

medical interventions. In fact, I think the TV show Scrubs said it best. I am considering offering full body scans here at Sacred Heart. What do you think? I think showing perfectly healthy people every harmless imperfection in their body just to scare them into taking invasive and often pointless test is an unholy sin. It does sound a little sketchy ethically, doesn't it? Thanks, Perry.

Please don't hesitate to give us a five-star review. It really means the world to us because it helps a podcast find a new audience. And if you want a really cool conversation about a similar topic, check out the convo that I did with Brian Johnson, who we actually referenced in this episode. As always, stay happy and healthy.

Thank you.