MRIs for healthy patients: A disconnect between MedTech and clinical needs?

If you’ve ever had an MRI, odds are your physician ordered the scan to get more context on your health. It was likely a response to certain “red flag” symptoms you reported, or inconclusive results coming from other scans, such as X-rays. 

But certain whole-body scan startups—namely Prenuvo and Ezra—promote MRI use to the general public as a means to increase the early detection of cancer. 

This raises the question: Do the potential benefits of the elective use of whole-body scans outweigh the risks? These risks include emotional distress from receiving inconclusive or false-positive results, unnecessary invasive procedures following false-positive results, and high costs.

Healthcare Huddle’s Jared Dashevsky recently published a scathing analysis of how and why promoting whole-body scans to the general public makes no sense (despite how lucrative it is), highlighting that many clinicians agree with him. Professional groups like the American College of Preventive Medicine have even made official recommendations against using these types of whole-body scans for early cancer detection in asymptomatic patients.

From our point of view, this case represents a significant disconnect in the MedTech industry. It forces us to ask: How might MedTech innovators and VCs better align their goals with those of clinicians?

The clinician’s perspective: When are MRIs appropriate? 

MRI—or magnetic resonance imaging—is a particularly effective, noninvasive way to study the organs and tissues in the body. The technology works by using the magnetic field inside the machine to temporarily realign water molecules in the body, which then produce faint signals with the help of radio waves and result in cross-sectional MRI images.

These scans can be used to study and diagnose malignancies in the brain and spinal cord, the heart and blood vessels, the internal organs like the liver and kidneys, the bones and joints, and even the breasts. 

When it comes to cancer detection, whole-body scans such as MRIs are recommended for patients with rare genetic predispositions, such as those with Li Fraumeni syndrome. 

However, when it comes to ordering whole-body scans for asymptomatic patients with no genetic indications, many clinicians agree: It doesn’t make sense. Even with MRIs, which don’t carry the same radiation risks as CT and PET scans, the risk of obtaining a false positive is too high.

In fact, a 2020 review in Cancer Imaging found that a whopping 95% of whole-body scans of asymptomatic patients result in abnormal findings. But upon further investigation, less than 2% of those findings were found to be potentially malignant, and even fewer cases resulted in actual cancer diagnoses.

In sum, the risk of false positives is very high when it comes to using whole-body scans on asymptomatic patients. 

Those false positives often result in the need for invasive further diagnostic measures such as biopsy and significant associated emotional distress. Also, the financial burden for the scans rests entirely on patients’ shoulders in the U.S., as insurance doesn’t—and is unlikely to ever—cover these scans with no medical indication of their necessity.

The Silicon Valley perspective: How to make money off MRIs

MRIs can be very lucrative. For clinicians and hospitals, using the machine on a certain minimum number of patients a day can justify the high cost of buying and maintaining the equipment. 

When it comes to whole-body scan startups, targeting a larger population of potential customers is where the profit lies. Instead of simply poaching patients with the indicated “red flags” from the doctors and hospitals who normally refer them for an MRI, startups like Prenuvo and Ezra provide whole-body scans to patients with symptoms, those with genetic predispositions, and members of the general public looking for some peace of mind. 

In his analysis, Dashevsky quoted from Prenuvo’s own marketing copy: “Rather than wait for symptoms to present and disease to progress, Prenuvo provides early insight into what is going on under the skin.”

Patients pay out of pocket for these scans, and the companies recommend that their wealthy, health-conscious target clients come back for a checkup scan annually, which generally costs around $2,000. This translates to reliable cash flow.

MedTech’s misaligned goals

Whole-body scans being marketed to asymptomatic patients is not the only example of MedTech prioritizing market trends over what patients need. According to several scientists and doctors, booming health tracking devices and nutrition apps still have to prove their medical value as well.

We like to assume that the founders behind these products have good intentions—we don’t want to imagine leaders in our industry as singularly profit-driven. This leads us to the conclusion that industry priorities are what push these startups to create certain offerings against clinical guidance.

Current approaches to MedTech innovation emphasize knowing the market, prioritizing reimbursement pathways, and identifying technology gaps. These priorities obscure the most important question MedTech innovators must ask about their products: Will this device actually help patients and users?

Just because a lucrative market angle exists (e.g., Quantified Self as a trend), doesn’t mean it makes sense from a clinical perspective—or that it isn’t harmful to patients or the healthcare ecosystem in general. 

Plus, as MedTech stocks plummet and healthcare costs continue to skyrocket in the U.S., the MedTech industry needs to evaluate its priorities with surgical precision. Part of that self-evaluation should include questioning which ventures are worth pursuing—for patients’, health systems’, and investors’ benefit.

Our take: A more aligned path forward for MedTech

To build the healthier world many MedTech stakeholders cite as their inspiration, founders and VCs need to listen to on-the-ground clinical perspectives of patient care. This input is what should determine which clinical innovations are safe, clinically useful, and worth the investment.

In this edition’s Reflection section, Hadi discusses the high burden of extensive bureaucratic regulation in Europe’s MedTech ecosystem. We wonder: In the U.S., to better align MedTech innovation with clinical needs, could more regulation along these lines be the answer? 

Or, as has been the case throughout American medical history, might healthcare consumers themselves push the industry to better consider their needs?

We’ll be following along and providing our perspective as the industry—and patients—use these technologies and decide.