Would you Pay $2500 for a Preventative MRI Scan?

[00:00:00] Dear listeners, welcome to Faces of Digital Health, a podcast about digital health and how healthcare systems around the world adopt technology with me, Tjasa Zajc. You may not have heard about Prenuvo, but you probably know Kim Kardashian. Or perhaps about Prenuvo because of Kim Kardashian.

[00:00:27] Prenuvo offers a whole body MRI scans for 2500 US dollars. About 3-4% of people get something discovered, 10% have detected changes that require follow-ups. When Kim Kardashian took this preventative test, she recommended it through Instagram. And that's when the word about the company especially spread.

[00:00:52] Influencer marketing is something that the company has been heavily utilizing in order to attract new customers. So in this discussion, you will hear the CEO Andrew Lacey explain how Prenuvo uses influencer marketing. Where does he see the potential of whole body MRI scans?

[00:01:09] In light of other preventative whole body scans, in light of other preventative whole body scans, new innovative approaches to prevention and things like liquid biopsies which aim to detect cancer early. Some people say these scans are only a status symbol.

[00:01:29] So I also asked him about that and about the future of prevention. This discussion was recorded at Health Europe. Enjoy the show and if you haven't yet make sure to also subscribe to our newsletter which you can find at FODH.substack.com.

[00:01:48] The newsletter only comes out roughly once a month and offers an in-depth overview of a specific topic. Now let's dive in. Andrew thank you so much for joining me for a short discussion about prevention, Prenuvo

[00:02:22] and where are we going with Hector sustainability by basically investing in help not just providing sick care. First of all I think in the eyes of many people they kind of learned about Prenuvo after the post by Kim Kardashian.

[00:02:41] So you invested a lot into just providing influencers and well-known people with free scans so they could just test them out and give you a free review. Can you talk us through a bit about how that would play to what impact that had on the company?

[00:02:57] Yeah sure, thanks for talking to me. We in some ways have a very old fashioned strategy as a business so we just want to provide a tremendously good clinical experience and in-clinic experience for our customers

[00:03:11] and the goal here is if you have a great experience then you'll tell friends, family, colleagues and so on and we will grow our impact as a result. What we found when we opened our first clinic in Los Angeles all of a sudden there were

[00:03:23] folks that were coming in that had really big audiences and no one has a big audience than the Kardashians. We're really excited when folks like this are themselves interested in sharing with their audiences their experience of the scan and it's had a huge impact.

[00:03:39] So the impact has been huge for us as a business but more importantly for the folks that have learned about us for the first time and then taken advantage of the service. So how do you track who actually was infected and had something discovered with the scans?

[00:04:00] I think it's three to four percent of people that come in to get a scan have something discovered. Yeah about four percent of people have what we call potentially life-saving diagnosis and this could be cancer that we typically catch on stage one, various types of aneurysms so

[00:04:15] cereboaneurysms or aortic aneurysms or abdominal aneurysms and then about another 10 or 15 percent of people have findings that require medical attention. They may not be life-threatening in that moment but they could develop into something that's chronic and life-threatening down the track and then 85 percent odd of people

[00:04:34] get a more or less clean bill of health and that for them is tremendous peace of mind. Yeah we can maybe talk about that a little bit more it's definitely very scary if you have something and I think with the rising incidence of cancer we very quickly think

[00:04:51] that every pain is cancer by itself. What additional maybe experiences did you had with that or feedback from the customers? I think there's a few things to bear in mind about pain and I would probably make three points.

[00:05:03] First of all lots of cancer can grow to be quite advanced without any symptoms whatsoever and probably the classic case of this would be pancreatic cancer which is now the fourth leading cause of death from cancer and typically symptoms don't present until the cancer has

[00:05:20] arrived at a stage where you really can't operate on there's not a lot you can do. The second thing I would say is there's a lot of pain that is we feel it but either

[00:05:29] we ignore it or the health system ignores it and a good example of this is ovarian cancer where a lot of women are used to feeling pain in their abdomen and they might ignore it

[00:05:39] and eventually when they feel that it's unusual they might go to the health system and their doctor's ignore it. And then the third thing is there's something called referential pain and this is where our pain shows up in places different to where the actual underlying disease condition

[00:05:55] is and a good example of this is gallbladder cancer. Gallbladder cancer most often presents as shoulder pain and what these cancer teachers is you may or may not have symptoms if you have symptoms they might be ignored the

[00:06:08] symptoms you feel might be disconnected from disease so really the screening cuts through all of that and just looks inside and catalogs everything that we find. As you mentioned basically by bringing in influencers you are creating a public

[00:06:22] awareness campaign for self-care but at the same time if we try to clarify what these scans are good for and when maybe they're not the best approach or how would you define basically who is eligible or for who it makes sense to prevent the MRIs because

[00:06:42] as we know there's a lot of skepticism in the medical community about to which extent these things make sense if you're a healthy person. For sure so I would start by saying this is not the best scan for everything what we

[00:06:56] believe is if you want to do one scan this is the most comprehensive coverage that you can get in a single exam so for example we will catch colon cancer at stage one but we won't catch it at early or we won't see the pull-ups that you

[00:07:09] see from the colonoscopy the same with breast cancer we're very good at seeing through dense breasts but mammogram can see what's called can see the early calcification and that's considered stage zero of breast cancer so

[00:07:22] these are what we do is complementary to standard of care screening and and so we always recommend that patients do what is standard of care and in addition to brinevo also do perhaps some additional cardiac imaging because the heart is one

[00:07:38] area that we don't see very well at least at the moment because your heart is always beating and you're always breathing so it can be very complicated and difficult and time-consuming to collect great images of the heart using MRI

[00:07:48] you're not the only player in the MRI space there's companies that are trying to decrease the time that it takes to do a whole body MRI instead of taking an hour or even more it will take 15 minutes so how do you see the field or

[00:08:04] the sector developing in this sense and how do you also see the skepticism again from the medical community because the standard of care is still to take several minutes for a very small piece of the body when MRI's hands are

[00:08:19] done yeah it's a great question and the answer to both is the same which is what a lot of people don't appreciate is that MRI imaging is a qualitative imaging modality what do I mean by qualitative it means that the hardware that you

[00:08:34] use the software acquisition protocols the radiologist training increasingly say AI all of these combine to increase the medical accuracy of the imaging that you're taking so the best analogy might be smartphone cameras I

[00:08:50] had a Nokia phone back in the 90s that took photos but the quality of those photos are very different to what I get from my iPhone 15 today and so a lot of the impressions that physicians have about this imaging may well be based

[00:09:02] on technology that is 20 years old and similarly for consumers it's sometimes very difficult to understand how do these different companies compare how do I compare Prenuva to someone else all I can say is this is the only

[00:09:15] thing that we do it's not a side business it's an additional thing we're 100% focused on making sure that we have the best hardware best software best AI and best radiologists so these exams are as accurate as they can be

[00:09:28] your positioning is as a preventative care the biggest challenge is obviously the cost the price of the scan is currently 2500 US dollars which is a lot I know that you are working on decreasing that price how do you see

[00:09:46] those efforts are coming along we know that genomic testing went from a million dollars for a genome to a thousand dollars and also if you look at pharmacogenomic testing it's around one K or a few hundred dollars if you

[00:10:03] want to do it and even that is too expensive to be routinely included into health insurance coverage as a scanning mechanisms so how are your basically efforts going into the decryption of price and how do you see this challenge

[00:10:21] with what insurance companies or healthcare is willing to pay for to make something a screening option yeah I think there are two thoughts I have on this the first is absolutely we're working to bring the cost down

[00:10:34] before we made the scan available to the public a similar exam would cost around fifty to a hundred thousand dollars at least in the US so already we're a lot cheaper and our goal is to bring it down to hundreds of dollars and we do

[00:10:45] that through scale we do that through speeding up the image acquisition time as you mentioned and then we do this through AI helping to make radiology more productive because radiologists are the most expensive

[00:10:56] cost but secondly I think there's a the philosophy I have here is this is a very different approach to healthcare we look at the entire body and we're screening every organ in the body for maybe 15 20 dollars so I can screen you for pancreatic

[00:11:11] cast for 20 dollars for lung cast for 20 dollars for variant cast for 20 dollars for kidney cast for $20 so we go through the entire body although the cost may be in the aggregate maybe a large number the coverage is also very

[00:11:22] big and I fundamentally believe that in the US now we spend about $15,000 per person on healthcare every year if we were to spend that amount of money at scale hundreds of dollars to do this screening we would save orders of

[00:11:35] major more in healthcare costs that are being spent right now on late stage disease and reactive medicine when a person gets a scan and if it's positive that's basically a beginning of the journey can you talk about how basically do patients that have something discovered present

[00:11:53] this to clinicians because this is an out of pocket expense and even in healthcare clinicians sometimes like to duplicate scans is they're done in another institution even if that's a medical institution so I imagine that here doctors might be even more reluctant to rely on the test if

[00:12:14] patients come with your results. Yeah it's also a really great question and I know less about the have less direct experience in Europe but I can say in the US what you described is absolutely true and I think that's one of the other ways in which these scans

[00:12:27] maybe challenge the way that we're doing medicine we see lots of things inside the body which we consider to be benign for example we have seen a lot of lesions cysts and mangiomas and these are benign things we want to check

[00:12:39] to see that they don't complicate over the years but there nothing that someone should worry about in the US healthcare system where there's a lot of medical litigation oftentimes those benign findings would be subject to a whole bunch of intensive testing our goal really and we counsel patients

[00:12:58] a lot when we give them the results this is benign don't do anything about it we'll check it again at a year or two so we're taking this watchful waiting approach and hopefully using that to avoid a lot of these unnecessary tests that are currently happening today.

[00:13:13] Which markets are you currently present at? We're in North America so Canada and the US and we're opening in London later this year and also we'll be opening in mainland Europe early next year. What are your expectations of the European market here at Health Europe

[00:13:27] where we're basically discussing how different healthcare systems compare and cultures also have different attitudes towards how much they're willing to spend before healthcare. New York Times said that MRI scans like these are a set of symbols so obviously

[00:13:43] you're also going to have a wealthier population that's going to be willing to pay for this so how are you thinking in terms of the business strategy for Europe? I think by the way where we have more things in common than we have

[00:13:55] differences like everyone wants to live a longer and healthier life and that's true for Europeans just like it is true for Americans. And I think now particularly coming out of COVID people are much more focused on looking after themselves and we see this in people doing more

[00:14:09] exercise or investing in organic foods and so on and in some ways doing a preneuroscan is similar to those activities it's about making sure that you don't get sick in the first place.

[00:14:19] I have a lot of hope that this is going to be a really big market for the company and because a lot of the healthcare system challenges are the same in the US as they are in Europe I expect that will have a

[00:14:29] similar impact as well on healthcare. Who do you see as your biggest competitor in the space? At the end this might sound flippant but at the end of the day I think our biggest competitor is just lack of awareness that this technology exists.

[00:14:42] We're on a bit of a crusade right now and that's why you see us leading into working with influencers and people with large audiences because people don't know that this category of service exists and the more people I know about the more lies will be saved.

[00:14:56] Okay and do you also offer any counseling even before people take the scans and going back to the thinking that when you raise the awareness whenever people are gonna feel unwell they're gonna be like I'm gonna get all the answers by getting an MRI which is not

[00:15:12] necessarily the case. If I'm being honest we survey everyone that comes in to get a scan and we already asked we asked them at the outset what's your level anxiety about health and three out of ten people consider themselves very anxious about their healthcare.

[00:15:28] We survey people after the scan in fact several months after the scan we said okay how anxious do you feel about your healthcare now and universally that level anxiety drops and for every one person that we might make feel in their eyes more unnecessarily anxious

[00:15:46] maybe because we tell them about something that they may not feel like they can do something about. We are curing anxiety in about 30 people so we are in the business of reducing anxiety as a company not creating it.

[00:15:58] The space of preventative health and diagnostic is very big so I just want to pick your brain on how do you see this developing for example we see full body scans that are not based on MRIs I'm referring to NECO Health which they have their completely

[00:16:16] own technology then there's liquid biopsies which are still in very early stages but the hope of the company's developing these solutions is that this would be just a regular blood test that the doctor with order at an annual

[00:16:29] checkup and yeah I guess the one thing to mention is that when we're talking about liquid biopsies because it's based on DNA they might even detect changes in proteins, cancer and detect cancer even before it's visible on an MRI scan because for

[00:16:46] an imaging test it has to be quite big already so that you detect it so how do you see the whole landscape of prevention health and yeah everything that's happening in the field. I'm really excited about it there's tons of

[00:16:58] innovation and I think that there's not going to be one solution that solves everything I think it's a combination of these sort of innovative approaches that are going to help provide us with tools that we can all better manage

[00:17:10] our health and a health system can more focus on proactive medicine than reactive medicine I think that's great I'm really bullish about all these technologies I think liquid biopsies as it is and will continue to become more and more accurate I think the work

[00:17:25] that we're doing in screening there's such tremendous innovation in the field of MRI sort of physics right now that we're going to be able to diagnose more and more diseases in the coming years and I think there's a lot

[00:17:37] of room for new imaging modalities like what Neco is is working on so yeah I'm really excited it's a really great time to be working in creative health. I mentioned earlier that some parts of the clinical community is a bit hesitant about solutions like yours.

[00:17:52] So what's your business strategy for all the entrepreneurs working in the preventative health space to change the opinion of clinicians or just to basically educate them as well or upscale them which is a huge challenge in digital health basically changing the awareness and knowledge about new technologies.

[00:18:11] I think one piece of advice I'd have for all entrepreneurs is a lot of people think of different channels as being choices. So you can go after consumer or you could go after physicians or you can go up to enterprise. I think with very transformative new health care

[00:18:27] you almost always have to start with consumer because consumers are interested and early adopters and it's through success with consumers that just gives you the makes it possible to then go after some of these other channels that may be more valuable for a company's growth in the long

[00:18:42] term. So I wouldn't listen to that path to investors and say don't do this and realize that building awareness is a journey and almost always starts with consumers and probably almost always ends up with health systems but you can't go straight to health systems if you haven't

[00:18:58] passed through the other stages. You're a serial entrepreneur so you built other companies before CRENOVA. What's different now like how do your challenges differ now anything to share in that regard. To be honest all of my companies have been different and they only have one thing in common

[00:19:17] which is I always end up doing things that a lot of people don't believe in at the beginning. I am somehow attracted to these types of opportunities so my first company was a reverse first iPhone mobile company when no one believed in iPhone

[00:19:30] and thought that it would be killed by Nokia. When we first started CRENOVA there were a lot more physicians there still are physicians today that question these exams but back then it was almost universal and I really I'm excited challenging these like conventional

[00:19:47] the conventional wisdom and I think it's if there's no resistance to an idea as an entrepreneur then probably it's not a very good idea because someone will have already done it. It's that resistance that tells you that you're working on something that could be

[00:20:00] potentially transformative and in the five years since we started the company we're now starting to see that yes we what we are doing is in fact really quite unique and special. You've been listening to Faces of Digital Health a proud member of the Health Podcast Network

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