The Daria Hamrah Podcast
Do you want to change or simply improve your life? Take your business or your personal relationships to the next level? Have you ever thought why change is so difficult? Ever wondered how people become successful and we just call them "lucky". The Daria Hamrah Podcast gives you Dr. Hamrah's personal insights and pathways to his successes and what he calls "true happiness". Featuring interviews with some of the most successful entrepreneurs, authors and experts in their field, he shares their insights into what he calls the "Secret of Life".
The Daria Hamrah Podcast
Revolutionizing Preventative Healthcare: The Future of Whole-Body MRI and AI with Andrew Lacey
What if you could proactively manage your health before symptoms arise? Join us for a groundbreaking conversation with Andrew Lacey, CEO and founder of Prenuvo, as he reveals how whole-body MRI imaging is revolutionizing preventative healthcare. Inspired by a transformative personal health scan, Andrew transitioned from serial entrepreneurship to pioneering a new era in health assessments. Discover the challenges and victories Prenuvo faced during its expansion amidst the pandemic and how it provided an essential alternative when traditional healthcare was constrained.
Tackling skepticism head-on, we explore the resistance and eventual acceptance of whole-body screening within the medical community. By drawing parallels to the evolution of mobile phone usage, Andrew envisions a future where MRIs are embraced as a preventative tool, potentially covered by insurance. This discussion highlights the critical need for early detection in reducing healthcare costs and improving patient outcomes, especially as healthcare expenses soar and populations age.
Artificial intelligence is at the forefront of this healthcare transformation, particularly in radiology. AI's ability to enhance diagnostic accuracy and track subtle changes in organ health is changing the doctor-patient dynamic, positioning physicians more as health coaches. Patients, especially those middle-aged, are increasingly seeking proactive health measures, utilizing tools like Prenuvo's scans to empower themselves on their health journeys. Tune in to uncover how AI and innovative imaging are shaping the future of personalized, preventative healthcare.
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All right, everyone, welcome to another episode of the Dari Hammer podcast. Today, my guest is no other than Andrew Lacey, who is a CEO and founder of Prenuvo, the company pioneering proactive whole body MRI imaging to detect cancer and other diseases early MRI imaging to detect cancer and other diseases early. Under Lacey's leadership, the company has expanded across North America and, as a matter of fact, we have one Prunuva Center here, close to where I am here in Bethesda, Maryland, Establishing Prunuva as a recognized and trusted proactive healthcare service for patients and referring clinicians. Lacey is a seasoned entrepreneur with extensive experience taking transformative products from conception to scale. His notable achievements include playing an influential role in developing the iPhone apps ecosystem as a co-founder of Tapalus I hope I pronounce it right which was later acquired by the Walt Disney Company.
Speaker 1:In addition to his entrepreneurial pursuits, Lacey has held key leadership consulting, strategic, financial and product roles across international companies, including McKinsey and the Walt Disney Company. In addition to his work at Pranuvo, Lacey is an advisor and investor across diverse portfolios and startups. And welcome on to my podcast, Andrew, and it seems to me that I would describe you as a serial entrepreneur, angel investor, health promoter. What do you see yourself as? What would you call yourself?
Speaker 2:Well, it's funny. Absolutely I'm a serial entrepreneur, although I think these days, unfortunately, the way that serial entrepreneurs treat their bodies and you know the way that serial entrepreneurs treat their bodies that also means I'm sort of a serial. I guess like sort of had a serial life of like poor diet, poor exercise, too much stress, not enough sleep. But I've been doing now building companies for the last 20 or 30 years, so that's about all I'm qualified to do.
Speaker 1:How's that working with trying you know you're trying to promote health of others. How are you promoting your own health? How does that work? You know you have so many irons in the fire. You have so many responsibilities, one of which the main one is promoting health and helping people with their health span and their longevity using MRI imaging, which we're going to talk about in this podcast. But you know, what are the things that you're doing for your own health, considering this busy lifestyle?
Speaker 2:Well, I would say, you know, that's really how I got started with Prenuvo was I had one of those moments where you sort of look in the mirror and you say, holy cow, you know, I'm not the 25 year old that I remember myself to be and I'm working so hard to build a better future. You know, how do I even know I'm going to be around for that future? And so that sent me off on a journey to sort of learn more about my health. And I found a gentleman who was doing an earlier version of a prenuvo scan up in Canada, and so I took a trip up there and got one of these scans and you know what? It was such a fascinating experience. It was the first time I really looked at every someone, looked at every single organ in my body. I could give me sort of a complete accounting of.
Speaker 1:Is that how everything started? Is that where the idea came with for Pranuvo, or was?
Speaker 2:it, yeah, yeah. No, it came from having this experience myself, and the experience really taught me a few things. Having this experience myself, and the experience really taught me a few things. Um, thankfully I wasn't sort of I wasn't dying of any sort of serious underlying medical condition. That was great, but I had this tremendous peace of mind, and that peace of mind was just something that's so hard to explain to other people that haven't gone through it, because I think for most of us, we always have this voice inside our head. You know, whenever we have an ache or a pain or we think about our lifestyle and we we have a little bit of concern, or if it's not inside our head, it's, you know, our mother or our father. They're telling us to look at, look out for ourselves better, and it just felt incredible to have that kind of clarity and it enabled me to approach life in a totally different way.
Speaker 1:And.
Speaker 2:I came back and a month later I'm like well, that was such a nice feeling. How can I live the rest of my life feeling that way? And so that was really the genesis of the decision to find ways to bring these scans to as many people as possible.
Speaker 1:How long ago was that? That was five and a half years ago. Five and a half years ago, so right before the pandemic.
Speaker 2:Correct, right, we have in the second clinic. Uh, right, I guess six months into the pandemic interesting.
Speaker 1:How was that experience? You know you have this great idea and now the pandemic hits with. You know I'm sure there is construction involved. I'm sure there is like a lot of things involved. How, how did that affect um the? You know, building the company and then building all these centers?
Speaker 2:well, it was interesting. We managed to stay open the whole time through the um, through the pandemic, and what happened during that period was a lot of hospitals and medical practices stopped doing preventative.
Speaker 2:Yes, yeah so people weren't getting mammograms, people weren't getting colonoscopies. There were people who had had cancer that was in remission but they weren't getting checked up on, and so we became known as a place where people could go to make sure that they didn't fall behind on that. And to my knowledge, we never I mean like any business. From time to time we had people that had COVID, but everyone was wearing masks and we never really identified any risks that we sort of brought to the patients that came in and, on the contrary, we were able to help people stay on top of their health during. So any risks that we sort of brought to the patients that came in.
Speaker 2:And, on the contrary, we were able to help people stay on top of their health during this really troubling two or three years.
Speaker 1:Yeah, I think for the audience I want to describe what your company actually does, so I can speak from personal experience. And it's interesting. When I found out about Prannuvo, it was really exciting for me personally because a year preceding that in my head, I was in my health journey and my longevity and health span journey, trying to just get my own health and my own life really on track because for decades I'd been neglecting it not in an abusive way, just not thinking about it, not being proactive and consciously thinking about it and I always thought I have a healthy lifestyle, I always exercised, I never overate, I never ate junk food, everything was in moderation. Now I know how much more I could have done, which I'm doing today, but it was during a time where I had heard about it sounded like futuristic. I had heard about full body MRIs but I had no clue where to go. You know, I didn't know of any centers that existed and I had just heard of it and I thought it's an amazing idea, almost like utopian, futuristic science fiction movie, where you see they put someone in a tube and AI analyzes the entire body and tells them exactly what's wrong and then put something on the injury and then it heals within two seconds. In front of you I did that type of futuristic science fiction, so it sounded like that to me, but I remember the feeling I had about it. I said that would be amazing if I could just get a full body MRI and see everything that's wrong or not wrong with my body. At least I know what to do, I have something to use, I have a visual guide that tells me about everything that's going on in my body where I can plan and be proactive about how to not just prevent disease but also undo some of the damages that have occurred as a result of my lifestyle genetics.
Speaker 1:And then I stumbled upon Prenuvo and I remember when everything was so seamless that I was shocked that it's something that not everybody knows about, and I hope that people, and mainly physicians and healthcare providers, will understand the value of it. So tell me a lot, a little bit, about what your experience has been introducing this idea, this concept, not just to the consumer, because I believe the consumer is ready. I know as a fact the consumer wants it, because I have people asking me about it. Everybody is on this health and health span and increasing their lifespan journey, at least in my demographics, but I see it throughout the country. But to me the interesting part is the average healthcare provider is still way behind, and it's very bizarre because it's almost like they've been brainwashed by our system, that they've been first taught and then they've been practicing in for decades, and now someone comes and tells them the earth is round and not flat and they're fighting you.
Speaker 2:Is it only me or has this been your experience dealing with healthcare providers? Well, I think it's. Yes, it's been our experience. But it's also it's understandable in the sense that so the underlying technology we use is MRI, and MRI actually has been around for 30 years. You know, the first MRIs came out in the 80s. In fact, in some of the hospitals out there they still have the originals because it's too difficult to pull them out and put a new one in. And the field has advanced a lot since then. The image acquisition has gotten faster, the image quality has gotten better. Faster, the image quality has gotten better.
Speaker 2:Um, there's increasingly ai that sort of enables us to do more with these machines than was ever possible, even maybe 10 years ago. And a lot of physicians maybe don't fully appreciate that this modality is a is not like an x-ray or a ct machine where, you know, those are quantitative imaging modalities. Mri is a qualitative imaging modalities. So all of that the hardware and acquisition protocols and the radiologist training and the AI, all these things just become they're really important determinants of how accurate the scan is, sure, um, and so it takes time for us to educate folks, um physicians, about. You know why it. It is what we're doing in particular. You know is sort of different and how you know what the industry is doing more broadly, compared to sort of 30 years ago and certainly compared to CT screening, which was something that a lot of physicians were familiar with 20 or 30 years ago and that was not a great technology to be looking in the entire body.
Speaker 1:So what are some of the things the cynics and the doubters tell you? It's shocking to me. You come across published articles trying to evaluate whether taking a full body MRI would be justified, based on some meta-analysis of a bunch of retrospective studies, just trying to reason why it's an overkill and completely neglecting the fact that stage one and two cancer is treatable, versus three and four is deadly. And that's where I dropped the mic. But what are what are some of the things that you've heard communicating with healthcare provider, especially with the cynics and the um, the, I would say the old school ones?
Speaker 2:well, to give you an. I mean, it's interesting those meta studies.
Speaker 2:Most of them were evaluations of studies that were done using a particular technique on mri called dixon and it used to take maybe 15 minutes and it was a fast protocol to see the entire body and but it, you know it was fast. Just because it fast didn't mean it was particularly accurate. Um, our protocol is now 45 minutes and we spend one minute doing a Dixon. So that's sort of 2% of what we do is the part of the exam that all of those meta studies were based on, and obviously we're collecting a lot more images beyond that and folks just don't really understand this.
Speaker 2:Whenever a physician speaks out against whole body screening, the first thing I do is I reach out for them and ask them hey, why don't you come in and see it for yourself? Why not experience it? Speak to my, one of my radiologists. You know, let's have a dialogue here. If you still feel the same way after you've gone through that process, you know, god bless you. You know, keep fighting the fight against, against whole body screening. But unfortunately no one's really taken us up on that offer.
Speaker 1:Why do you think that is? It's very bizarre to me.
Speaker 2:I mean, the only real conclusion one can draw is that it's sort of a dogmatic approach that's not based in evidence.
Speaker 1:How so?
Speaker 2:I mean the evidence would be the results of the image no, I know, I agree, but I guess the stance that some of these folks are taking is a dogmatic stance, you know, and if they were truly interested and open to learning about these techniques and they would have taken us up on those offers it's very, very strange.
Speaker 1:You would think I'm a health care provider. You would think I always think people think like I do and it's confusing to me when they don't. And so when you're a healthcare provider, as someone that should be promoting health, should be preventing disease or trying to be ahead of disease that one tool you have to be able to look into one's body better than any other tool you wouldn't want to look into it. It's very strange.
Speaker 2:Well, and it's even worse than that because it's not like our health system is on a particularly good trajectory, you know, and with aging population and health costs going up, I mean, uh, you know, the health system is projected to cost three times more in 15 years. I mean, who's going to pay for that? The government won't be able to. I'm not sure employers are going to be able to. Um so, so, so. So either the consumers will be paying or we will be rationing care, and I don't think either of those are great outcomes. So now really is a time for people to have a certain level of curiosity about different approaches to health care, and that's really what we're trying to do at Prunivo, and, you know, that's why we're excited whenever we can get physicians in to really help them understand how these protocols can change the way they practice medicine.
Speaker 1:Have you been able to convert some of the doubters in Cynic and where they said, wow, I was not aware, I'm glad I did it. Do you have any stories?
Speaker 2:Oh yeah, I mean in fact, even when we speak to investors, I say kind of one of the most interesting things about this company, and almost any transformative company shares this characteristic which is, you know, before people really understand and experience it, most of them are skeptical. And when they experience it, then they become believers. You know, that was true for Airbnb, that was true for Uber, you know, and I think that's true for us, because 80% of physicians are skeptical, you know.
Speaker 2:Know, when they hear about us, um, if they come and experience that over 80 refer us patients routinely so it's a complete mindset shift and uh, and that sort of information asymmetry, I think is in some ways gives me a lot of faith that you know we're on the right track here and you know we're transforming health care.
Speaker 1:I think you have a lot of uh, that you know we're on the right track here and you know we're transforming healthcare. I think you have a lot of perspective in that regards. I've read about when you were trying to develop apps for the iPhone, when people were still using and hard set on their Blackberries and Nokia phones and you know, probably they were making fun of you about 20 years ago. Think you know, and look at us now I mean there's an app for everything. And tell us a little bit about that perspective and how are you utilizing that perspective going into other businesses as well as Prenuvo?
Speaker 2:Yeah, well, there's just a lot of. You know, I believe that analogy is sometimes the best. Uh, teacher and I often talk about mobile phones as sort of an analogy for mris. They have been around for 30 years as well, and it was only when apple said, hey, you know, we want to have a touch screen and we want to make this thing, you know, behave in a different way, have a different ui, all of a sudden it unlocked this entire different use case for a phone, and now people buy phones not to make phone calls. They buy phones to do everything else. And today the market for MRIs is 99% diagnostic. You have a problem already and we use these machines to better characterize that problem. I believe the future market for MRI machines is going to be 99% screening asymptomatic patients, you know, and that use case is going to, you know, it will take over this industry and it's only a matter of time.
Speaker 1:What's your prediction?
Speaker 2:Well, it took. It's so hard to imagine. Um, that mobile company that we started. We started in 2009 and you know so we're 15 years. 15 years ago, we didn't use phones for anything other than making phone calls. So I mean, it's been a tremendous change in a relatively short period of time, and medicine is not known for moving things along very fast.
Speaker 1:Not at all.
Speaker 2:But I think in 10, 15 years time everyone's going to be getting these. I hope they're covered by insurance. And I'll tell you what. If that was the case, our health system would be much less expensive than it is today, because much of what's driving those costs is reactive medicine prevent late detection of cancers in specific or other chronic disease, whether it's neurodegenerative disease, whether it's cardiac, whether it's GI, anywhere in your body.
Speaker 1:You know, that's where I see, as a clinician, the value. Even as a patient for myself, I see the value. I want to know things when they start happening at a cellular level, using blood biomarkers and visually using MRI, which is the greatest detail, before even clinical symptoms occur. I mean, ideally, that's why we're doing it and technology allows us to do it that way. And so now the question is why wouldn't you do it? So I think me and you both agree on that and there's we don't even have to debate that and any anyone that wants to debate me, I would gladly invite them because I would I yet have to hear an argument against it. The the question here is I don't understand. I guess I don't understand how that would fit into the insurance model and correct me if I'm wrong. From my view, insurance model is based the way they're profitable Because, especially a lot of insurance companies, they own actually the pharmacies. For example, aetna owns CVS, so they have a whole system, a whole model that grows and makes money based on. It's a recurring thing, so people get sick, they are in need of prescription medication, and the longer we can keep those patients alive on medication, the more profitable it is for the insurance companies. And the pharmacies not want to promote health because they're paying out a lot for our health care, of our sick care, when we're sick. Insurance companies make money, right, well, yes.
Speaker 1:However, if no one gets sick, really if no one gets chronic disease, insurance is going to eventually become less attractive. Because the attractive? Because the reason why people get insurance is not because they constantly get sick. It's because they're afraid of getting sick and not being able to afford their health care or their sick care, and so, therefore, they buy insurance.
Speaker 1:The same thing with life insurance, the same thing with car insurance. If I know I never get in an accident, why would I get car insurance? I'm not going to pay for car insurance if someone told me you're never going to get in an accident or you're going to drive this car and the car you can hit anything, the car is not going to break down, is not going to get damaged, so why would I get car insurance? So, for insurance companies, how is that attractive if we prevent chronic disease or make the disease processes shorter, by not having someone on chemotherapy for five years, or someone being in the ICU for a year and then being in some home health center for 10 years, for 10 years? How does that, how do you see prenuva something being proactive be attractive for an insurance company?
Speaker 1:and why would insurance companies cover it, not that they have to, but I'm just putting that question out there. Have you thought about it?
Speaker 2:yeah, there's a lot to unpack there, I think I mean, first of all I you know there are a lot of well-intentioned people in health care, in all parts of it. So despite all of the best intentions, the system seems to not work really in a very optimal way for the patient and I think you know we need to look at that. But I would say, as it relates to preventative health and screening, most of the advances have come through governments legislating that insurance companies have to cover these evaluations.
Speaker 2:So you know, Obamacare made it such that every insurance plan had to provide a certain level of preventive health, including mammograms and colonoscopies and so on. Since then, a lot of states have legislated to provide breast MRI for women that have dense breasts. So a lot of it has come actually from the state and federal governments. And so, you know, I would imagine, at some point in the future, if there's political will to really, you know, stand behind the notion that we need moonshots in healthcare, then I think you know where that impetus is going to come from is from governments to say you know what you know, we see the future of our current healthcare system Today, 10, 20 years down the track. We don't like what we see. We need to try something fundamentally different, and so we're going to ask that you, we're going to insist that you mandate coverage for these additional preventive procedures. I think that's generally how change would happen. I 100% agree with you these additional preventive procedures.
Speaker 1:I think that's generally how change would happen I 100% agree with you, I think without the government mandating the insurance companies. And that's the other challenge, because there is a lot of funding going on the other way. So there is a lot of financial bias involved there too. But it really requires a non-corrupt government, a non-biased government, non-biased government, non-financially biased government to have the power to mandate and not to get tempted in taking funding from insurance companies and pharmaceuticals. Uh, you know in I don't think it's a secret anymore that that's happening. But it requires a real, independent government for that to mandate. And you know we'll see if that happens. You know we're going to have a new administration now, starting in January, and with a government that is all about promoting health and making us healthier At least that's what they claim.
Speaker 2:So we'll see how that will unfold well, I think there's one other aspect to this which is a little harder to sort of get one's head around, which is sort of a moonshot involves in some way like suspension of disbelief, like for me that's inherent in the, in the sort of definition of a moonshot and I think, as a health case. You know, if you go back 200 years you had people selling snake oil and there was no such thing as a clinical trial. And now we've got pretty good at clinical trials and you know, and that's saved a lot of lives. But the method of running a clinical trial generally is most easily applied against an incremental improvement to the way that we do health. So that could be a different drug. You know drug, everyone's using drug. A pharma company, you know, invents drug b. We can run a trial to compare drug b against drug a. Drug b is better than that one. You know, become that. That's the winner. That's the next blockbuster drug. And it's pretty easy because you can sort of hold all of the rest of the health care system of static. It behaves the way it has always behaved.
Speaker 2:The challenge with preventative health is sort of everything is downstream of perennial health. If you imagine a world where you catch everything early, the rest of the health system wouldn't behave the way that it behaves. It would behave very differently, you know. You would have a different set of clinical care pathways. You maybe would have a pharmaceutical industry that would dust off drugs that had failed because they had tested them against advanced disease and we would have a whole new set of drugs that might help solve some of these intractable health problems like dementia. Because we can see it early. The health insurance world would have to behave really differently, and so it's really difficult to evaluate fundamental changes to the healthcare system because you can't hold the healthcare system static while you're sort of evaluating them, and I think a lot of the arguments against whole body screening sort of make that mistake by saying well, you know, if you find something early, there's going to be a big cascade of unnecessary testing, because that's what we do in the healthcare system. Well, you know you shouldn't you shouldn't do that.
Speaker 1:How about?
Speaker 2:thinking about changing the way that you sort of like manage disease?
Speaker 1:um, because that seems like a poor argument for not looking for it in the first place, and I think that's one of the from the studies that I've read, that's one of the main arguments. I read many studies about addressing the value and then the downsides of taking a full-body MRI, which is, oh well, a small discovery, will lead to a cascade of unnecessary tests. Yeah, but that's a healthcare system problem. That's not the MRI problem. That's a human behavior problem. So the human behind it needs to be educated, the system needs to be changed. But we can't use that as an argument why we shouldn't discover cancer early. It's such a bizarre argument that it has to do with dogma, what you mentioned. It also has to do with lack of perspective. You're so siloed, you're so in your own closet that you can't see what's around you. It's almost like not that I hope it for anyone, but I feel every person needs to get at some point in their life to get some sort of not a health scare, but a health concern where the mri solves it for them, in order to buy into it, to be able to get away from their old belief system or whatever opinion they have. And it's also an echo chamber thing. I talk to colleagues and we in medicine have also echo chambers and it's almost like politics. There's so much politics that exists in medicine. There is so much opinion that exists that people almost it's almost as if their opinions are facts and no one takes the effort to actually do their research. They just take someone else's word at face value, just because they respect that person. And and there's this amazing book written by, uh, dr mark mccary, who's actually going to be the head of the FDA now. He's an oncologic surgeon here at Johns Hopkins, around the corner from me, and he wrote that book called Blind Spots how Medicine Got it Wrong. I don't know if you've read it, but he beautifully, you should read that because he hits the nail on the head. He literally describes why, um, science is something like we call science, but then half of the science, several years down the road, is debunked and and then is is is basically 10 years later. You show how this certain study that became a landmark study. They spent, like in the case of the Women's Health Initiative study about a hormone replacement 20 years ago, which was the most expensive study over $2 billion. It was the most expensive study that was funded by the NIH that falsely claimed that hormone replacement therapy increases the chance of breast cancer in women. So a whole generation of women lost out on the chance of hormone replacement therapy and changing their lives just because of that study, which was 10 years later completely debunked and it was proven that the primary investigator was heavily biased and none of the other there was like 20 other investigators on the study actually looked into it and just took his word for it and got their name on the paper and it became the Bible. Until today you will find OBGYNs or endocrinologists arguing that hormone replacement therapy can cause breast cancer. It's shocking. So I think, medical bias, even though we call it science, unless you really look into the.
Speaker 1:The devil is in the detail, unless you look into the details and take the time to read these articles yourself and have the ability to interpret it correctly and know where the weaknesses and strengths are. One of the things that you mentioned beautifully is these MRI scans, which were the older technology. They were not as detailed. Of course, they can't tell you what's on the image compared to our current technology. So another thing I want to talk about is the different types of MRIs. I know some people argue that these MRIs aren't specific enough. For example, let's say you want to evaluate someone's brain for neurodegenerative disease, or you want to evaluate the cardiac vessels, or other vessels for that matter. What are the current limitations and what technologies are out there that would solve those issues that can us in greater detail what's wrong with it, give us a more accurate diagnosis?
Speaker 2:Yeah, well, the starting point really is to say you know what's your objective function, what are you trying to solve for and for us? As a company, we wanted to have a scan that would be under an hour. You know 45 minutes to 50 minutes that could be diagnostically relevant for the most number of things that could kill you or seemingly affect the quality of your life. So that's sort of our philosophy. And you know the scans have evolved. You know, every couple of months we update our protocols, we add something here, we remove something there, we introduce a new sequence, but we're always trying to make this optimization work. How do we get the best bang for our buck? Because more than 50 minutes people don't like being an MRI machine.
Speaker 2:I think mine took like 45 minutes or so, yeah, so in fact, speaking about old machines, if you go to some of the original hospitals, you know the big teaching hospitals. They do whole body MRIs for cancer predisposition patients, typically teenagers. It takes three hours and they need general anesthetic, jesus. So you know that's what the existing machines in the healthcare system are able to do and that's why, you know, being able to do this in 45 minutes to 50 minutes was a game changer for screening, but we're always making these decisions. So these scans are very good for picking up solid tumors.
Speaker 2:They're very good at looking at the brain. They're good at looking for aneurysms we have a particular sequence that is very good at looking for hardness in the body, and there are two things that are hard cancer and also inflammation. So it's good at picking out, for example, digestive issues or RA or RA. Where we're not so good as a dedicated scan would be the heart, mainly because it just takes so long to image the heart. We haven't figured out how to stop it beating while you're in the machine. So that's one area where most people, if they had specific heart concerns, we would recommend that they also go and get a CT angiogram or a calcium score. And then the joints probably is the other area where we look at them sort of superficially. But if people have a particular problem with a joint, it's going to be easy and inexpensive to go get a dedicated set of imaging of that joint itself what's the difference between that dedicated image and your image, which covers the whole body?
Speaker 1:is it just like a software thing? Is it a time factor? What is it specifically?
Speaker 2:well, most of the images that we take are at diagnostic quality levels, so there really isn't any difference. When we take the images of your brain, they're equivalent to what you might get from a diagnostic MRI of simply the brain. The main, I would say, difference is that we don't use contrast, and contrast with MRI is this heavy metal that gets injected into blood so that we can visualize better the blood vessels, and that's particularly useful for looking for cancer better the blood vessels, and that's particularly useful for looking for cancer, um, uh. We instead rely on hardness, that the idea that tumors are always harder than the surrounding tissue. That's why women are told to feel their breasts for lumps. Not every lump is a cancer, but every cancer is a lump, um, and so we use hardness as a way to screen, and then every so often we find something that we can't fully characterize and we send the patient to do contrast imaging. But we don't want to be injecting something, a heavy metal, in a person's bloodstream if they don't need it, particularly if they're getting screened every year.
Speaker 1:How about the brain? How about the functional MRI of the brain, using like the subtraction mri? Are you able, are you guys able, to do that?
Speaker 2:we're doing a lot of experimentation, so our brain scans are going to evolve actually in 2025 how so right?
Speaker 2:now mainly to get more functional uh, information about. You know how the brain is aging, so looking at perfusion in the brain, trying to get a sense of the patency of the neural tracks as well, and writing a sequence called SWI, which is particularly helpful for people that might have had traumatic brain injury. So we're experimenting and looking at all these and we'll make some changes in the future. What we're doing right now is, um, we do on every patient a sequence that is typically only done on alzheimer's patients, and this is a very, very detailed quantitative brain scan that enables us to measure the brain volume of different parts of the brain. Now, if you come in for one scan, that doesn't tell us too much about your brain health, because everyone's brain is unique. Sure.
Speaker 2:Some people have big brains, some people have small brains, and how smart they are is sort of not necessarily highly correlated with the size of the brain, right, but what we care about is how that brain volume is changing over time. And once you hit your 40s, on average, your brain is going to shrink around 3% per decade. Hit your 40s on average, your brain is going to shrink around three percent per decade. And so with two or more points in time we can start to help you understand. How is your brain changing as you age? Are you able to maintain brain volume? Is it shrinking at an accelerated rate? And these all become really early indicators of neurodegenerative process, ideally at a point where you can still just make lifestyle modification and sort of arrest the progression of that disease.
Speaker 1:I would hope someone thinks about making those lifestyle changes before that occurs, right? Because I mean, once your brain shrinks it's really hard to get it back, even though there are studies, especially of the amygdala, showing that if you walk like just a mile a day you can increase the size of the amygdala and with that decrease the chance of dementia or slow down the progression of dementia or alzheimer's well, the reality is there are interventions but also we don't know because we aren't imaging disease as early as we're able to see it with prenuvo yeah so you know, um, uh, take even sort of msk degeneration, so spinal degeneration.
Speaker 2:You know I had a very, very mild uh disc bulge in my cervical spine and this was like five years ago and you know, because I spent a lot of time in front of computers and obviously a lot of time looking at phones, and so I went and got a treadmill desk and now I walk three or four hours a day while I'm working and five years later my spine, you know, certainly hasn't got any worse and and, if anything, it looks a little bit better. And so I don't think we really even know, you know, to what extent we can not just stop but even reverse some of these conditions, because you know we almost define the condition by being at a chronic stage. You know there's only chronic kidney disease. There's no early stage kidney disease.
Speaker 1:It doesn't exist, there's's only dementia.
Speaker 2:There's no, like you, you know, uh, no sort of. It's not defined as like the thing that happens 20 years earlier.
Speaker 1:That sort of sets you on that path yeah, I think for me that's where I see the value with this, because a lot of us, if we are confronted with an idea, with a hypothesis, like we go to our doctor, they say, okay, you have high blood pressure, for example, or you know you got arthritis, you know the common stuff where your sugar is borderline high, it seems like a very abstract thing for someone to digest and, as a result, hard to make a change. Because I think a human brain, the way we, we work, you know, uh, talking about the brain is we don't believe things until we see it. It's almost like if we see something visually, it's more compelling, more convincing to then make a change because, um, we might, even though we trust our doctor.
Speaker 1:but you know, it has a different effect when someone just tells you sounds almost like someone is preaching, like you're listening to a broken record and then so you're less inclined or you're less motivated to make a change and I think psychology has a lot to do with it has this huge value as an educational tool, but also as a tool where the patient, for the first time, can literally see for themselves what's happening and then having compelling enough evidence to make lifestyle changes or choices. For example, let's say someone is in denial about the fact that they're becoming more forgetful and is slowly creeping in dementia and even their doctor says ah no, this is normal, you know, because maybe it's subclinical, it's normal You're just getting older, but I don't think you have dementia. So you're completely relying on the doctor's ability to diagnose based on clinical signs and symptoms. And we all know there's almost there's some number that 30% of cancers get misdiagnosed, whether over-diagnosed or under-diagnosed, and so you have basically to depend on the specific physician's ability to diagnose based on clinical signs and symptoms. Specific physician's ability to diagnose based on clinical signs and symptoms.
Speaker 1:Now you have an MRI that you took five years ago and now you're taking it and you can actually show quantitatively that it shrunk by 3%. So now you have evidence. You're like well, wait a second, maybe the patient is not imagining that they're forgetful or they have short-term memory loss, and because this is pretty congruent with what we can follow from the MRI. And I think it's different when a patient sees that and then believes it, and then feels compelled enough to say you know what, maybe I should go out on a walk every day, maybe I should stop eating sugar, maybe I should exercise more, maybe I should hydrate better, maybe I should, you know, take certain supplements that help that. All these lifestyle changes now have a better, I guess, chance to succeed and then improve the patient, and I think that's where I see the power.
Speaker 2:Well. But I would go even further and say you know, the sort of good and bad of our bodies and the organs inside them is that there's all this plasticity, so you can actually do a lot of damage to an organ and the organ still behaves normally until it sort of hits a tipping point.
Speaker 1:True. And so you know there's a lot that's going on when you're still pre-symptomatic.
Speaker 2:Um, a good example of the brain is you know, we can start see small vessel ischemic change and and you, you are as high functioning as you've ever been. You know the I don't know what the brain does. It sort of reroutes the neurons, but like there's brain tissue that's dying there, yeah, and it's just a matter of time.
Speaker 2:Yeah, it's just a matter of time. And I do agree with you. That sort of a picture is so important. You know, in in europe, on the cigarette packets they have these pictures of these horribly diseased lungs. You know, I don't know why anyone would smoke when you see those pictures it actually worked.
Speaker 2:You know, there's studies that show that it actually worked well, we show people I mean, I've shown smokers, you know, okay, here's, see all this like white in your lungs here, this is inflammation. So in the apex of your lungs and, by the way, this is where lung cancer likes to start, um, you know. So put that on your fridge, you know, next time you try and quit, and you know, see how that. Or you know, we can show people that little white matter lesions that a patient might get in their brain from high blood pressure. It's like next time you think of high blood pressure as an abstract thing and you ask, ask, why should I take my medication? Well, this is why, um, so the picture is so powerful for you know, for as a catalyst for change there is.
Speaker 1:I'm glad you mentioned the cigarette thing. There's nothing more powerful than visual tool and I think one of the success stories in reducing the number of smokers was those pictures and even writing that, just reminding people that it can cause cancer. And that movement really was significant. But it was like you said, it was mandated by the government and without the government it wouldn't have happened. And I was joking with a colleague of mine the other day. I said they should put these same images on a cereal box or on all these prepackaged junk foods or you know, a picture of your gut, a picture of your brain, a picture of your heart or fatty liver. They should put pictures of that and that would probably change human behavior.
Speaker 2:Well, although it does sort of you know, I have European friends that still smoke, so it does it also highlights just how important psychology is in sort of proactive health and preventive medicine, because you know my friends will look at that picture and say those aren't my lungs, my lungs are fine.
Speaker 2:That's denial, I mean you know they'll, they'll, they'll even hear about these scans. I mean the number of people I run to and say, oh, that's incredible what you guys are doing. I'll have to do it one day. I need to get around to doing it. Or I don't want to know. It's great what you're doing, it's fantastic You're saving lives, but I don't want to know.
Speaker 2:So there's psychology here and you say it's denial, but in some ways we think of that as being the sort of like a weakness of the individual. I don't believe it is. I believe that we, a consequence of the sick care system that we have, means that disease is only ever diagnosed at an advanced stage. And if the only you know so, we have now been conditioned to believe that being diagnosed with anything is a scary, horrible, life-changing thing. Why on earth would you want to go and look for something like that? And that's where I feel like the psychology is so important, because you know, we've been conditioned.
Speaker 2:I still get a little nervous when I do a scan. I've done five of them. It's that deeply, you know. I speak every day about this and I still get a little nervous because I am a product of that system as well. I grew up around people that were diagnosed with advanced cancer and so on. My parents came from that generation, the stoic generation, where no one wanted to know. Because, again, why would you? It's horrible. The psychological barrier is, I I think, the most powerful one to you know, for people to really sort of like look after their health and do what they actually sort of, in their heart of hearts, knows is right for them yeah, I think you hit the nail on the head.
Speaker 1:I think, um, I'm very certain actually I don't think I'm very certain that it has to do with the fact that we're conditioned that way, that our healthcare system conditioned. It's the same reason when you go to the dentist. Every time, people hate to go to the dentist because every time you go to the dentist, they find something and tell yep, you need a filling here or you need a crown there, or something is broken there, and you dread it. You always dread it because you're like as long as I don't have pain, I guess everything's fine. So why would I bring on the bad news early and ruin my time, my life and and that psychology? I think that is human conditioning and it's a personality thing. You know. I could tell you, one of the life-changing things I witnessed wasn't actually my patient, was a family member that had complained of headaches and it was back in Canada, in Vancouver, and my wife said, like, yeah, my uncle is complaining of these headaches. What do you think he should do? Like I don't know. I mean, how old is he? Like, what's his medical diagnosis? Like, what other underlying conditions does he have? I mean, I just, there's so many things. I mean, what do you want me to say? It's like, yeah, so he has these, has had his headaches that um just started in clusters and then now it's kind of like permanent and they're piercing. It's really debilitating.
Speaker 1:I'm like well, uh, does he have like migraines? Is he ever diagnosed with migraines? I mean, he should probably need a. He probably needs a brain mri if, if it's progressively getting worse and nothing takes care of it. This is well he has been telling his doctor. His doctor said well, you know, just um, insurance won't cover it yet, so it has to. A certain time has to pass with consider they love this word conservative measures before they can approve an m, and if that doesn't work, then they'll approve for an MRI.
Speaker 1:And so a month passed and the symptoms got really worse and it's like he's really suffering. I said, well, have him just go at an MRI center and just pay out of pocket, just get a freaking MRI. Like it's like 500 bucks for getting a brain MRIs. So he's like, yeah, that's a good idea. So then he goes like well, why should I pay out of pocket if it's covered by insurance? You know we talk about conditioning. That is another way of conditioning is these insurance companies. They condition you, they give you this illusion that you know if you pay out of pocket, you wasted your money, because why else are you paying for insurance? And in the case of Canada, he wasn't even paying anything for the insurance. It was, you know, government insurance. He finally got an MRI prescribed, but he wouldn't be able to get it immediately. He had to wait nine months. After nine months long story short he gets an MRI. He had a brain tumor the size of a tennis ball. Two weeks later he dies wow.
Speaker 1:I know. So that has always stuck with me and you know we all have a holy shit moment, whether it affects us personally. Hopefully it won't affect us personally. Hopefully we can learn the lesson from someone else's mistake, which is tragic enough. But it was always in the back of my head, and not that.
Speaker 1:I live my life every day thinking what if I have a brain tumor? But the fact that I have the peace of mind that I could literally walk into a center without asking my doctor or the insurance company for permission, and to get an MRI scan and to detect the brain tumor when it's a size of a peanut instead of a tennis ball, I know it would be curable, at least have a much higher chance of cure. And so, to me, this is where I again I drop my mic for anyone that wants to argue with cure. And so, to me, this is where I again I drop my mic for anyone that wants to argue with me. They want to say, oh, the chances, according to studies, is less than 3% or just some arbitrary number. I don't know the number, but it's pretty minimal. Well, 3% or 1% out of 1000 people or out of 100 people, that's one person that you save one life out of a hundred. That's a lot. There is 7.7 billion people in this world. You know how many billions of lives would you save with that, or hundreds of millions? How could you argue against that? So the argument is just so bizarre that it doesn't even make sense.
Speaker 1:So I think the fact that your company is able to provide that direct to consumer, just like companies like Function Health or Insight Tracker are able to bring biomarker testing to the consumer without the need of getting a prescription from a doctor to check 140 biomarkers and knowing exactly what your levels are whether it is your allergies, your DNA predisposition from your cholesterol, sugar, vitamin levels, all of those things and then what the next step in my mind is is AI using to interpret all of that in within milliseconds, without human error, without human opinion, free of bias and opinion, which is huge in medicine, like we talked about where do you see the power of ai? Is it something your company is talking about? Because I can only imagine you are creating this huge library of images that you can feed an AI computer and you can help an AI computer make this diagnosis that a human eye couldn't make. Is it something that you guys are. I'm sure you guys are looking into it, aren't you?
Speaker 2:Yeah, no, we definitely, definitely are. I mean the. The theme really is what you touched on around blood, for example. You know we get, let's say, you go get a cholesterol test. You know you're you either have normal cholesterol or you have abnormal cholesterol. So there's it's sort of like a binomial test. But we all know, if you do enough of these tests, that you know your cholesterol can trend in a certain direction and it's good to know about it before it becomes, you know, quote-unquote, abnormal.
Speaker 2:Uh, the inverse is true. You know, if you're working on your health and you you do serial cholesterol tests, you can see really the impact of um lifestyle on reducing these numbers. So you know, I prefer to think of health generally as as something that's on a spectrum, not, you know, you're either healthy and then you're unhealthy, and I think um prenuvo is all about that as a company. Uh, of course the challenge is that it can be very challenging for radiologists to look at for very, very subtle signs, very, very subtle changes from one scan to the next. So if you look at the spine, you know it's very difficult to say, oh, you know, that curve angle of that vertebrae changed like one degree from your last scan. You know.
Speaker 1:Plus, you're depending on the radiologist's skill, which varies hugely.
Speaker 2:Correct. There's obviously a standardization and a consistency issue, and we've also found some radiologists, you know, will read scans differently depending on the age of the patient, whereas we want to just be objective and give everyone sort of very clear information that they can act on whether they're 80 or whether they're 40. And so AI really helps us. It can help us understand this very small change over time, us understand this very small change over time.
Speaker 2:Uh, we're building algorithms right now that um are designed to help you understand how each organ in your body is aging relative to your biological age. Um, so similar to what you might have seen in an epigenetic clock where it looks at sort of the dna age, we're able to look at the organs themselves, look at the brain, the liver, the kidneys, the pancreas, the spine and so on, and what we're finding is obviously everyone has something different to work on, and some of that is based on lifestyle, a lot of that is based on genetics and you know, people perhaps don't really understand that you might have, you know, fit people that run triathlons, but they have fatty liver.
Speaker 2:You might have, uh, you know fit people that run triathlons but they have fatty liver. Uh, you might have generally healthy people have a kidney disease. So, um, it's, it's ai really helps us understand sort of how we're tracking in our health and, again, like it provides like a way for you to see your health journey as something that is, um, you know graduated, not just you know healthy, and then I'm, I've got advanced disease.
Speaker 1:Yeah, I think these gradual changes showing relative trends in your health, that's the power and that's even with your biomarkers, that you can get tested. That's a power of that because it's individual to you, where you know what lifestyle modifications you should be doing to improve that to you, where you know what lifestyle modifications you should be doing to improve that. And you know, actually I'm wearing a glucose monitor just so I know how my body responds to certain diets, to stress, you know, and then so I can manage those. I'm more aware of it. It just increases one's awareness and when you're aware of something, only then you can change it or take action. You're aware of something, only then you can change it or take action. You might not take action because, for whatever reason, maybe you don't care or you feel it's too much work, and that's fine. But I think we all have skin in the game and are motivated enough, at least the ones that live for the love of life and are not just waiting to check out or don't say, well, we're all headed towards the cliff. So what's the point? Kind of attitude, and I see more and more people I can't tell you in the past just two years alone.
Speaker 1:There's not a middle and specific.
Speaker 1:The middle-aged people that come to me that haven't taken initiative towards their own health outside of their network of their doctor, meaning on their own with direct to consumer stuff online, whether it's taking a whole body MRI, whether doing direct to consumer biomarker testing and that number is increasing significantly.
Speaker 1:It's incredible, at least in our demographics. I don't know what's happening in the rest of the country or the rest of the world, but we live in a very progressive area here in the greater Washington DC area and I could tell you, if I had to guess, I would say out of the middle-aged patients, whether male or female, age 45 to 55, that specific group, I would say 8 out of 10 are doing something. They're either taking a supplement or they're doing something aside of just going to their doctor, and they're highly curious just going to their doctor, and they're highly curious and they're very open to suggestions, almost like hungry. When I mentioned something like "'Oh yeah, can you tell me please more about it' I was thinking about it, but there's so much conflicting information online", so they're kind of lost and they, I think, as doctors, were a little behind the eight ball there in being able to guide these people that are looking to live a preventative lifestyle, a healthy lifestyle.
Speaker 2:Well, I think it changes, in fact, the relationship that doctors have with their patients.
Speaker 1:Oh, and trust, yeah, yeah.
Speaker 2:We have all these patients now that are, you know, coming out of COVID, they're so focused on preventive health. And there's a lot of companies like Prenuvo that are, you know, coming out of COVID, they're so focused on preventive health. And there's a lot of companies like Purnuvo that are you know, really are aiming to empower patients to sort of take control of their health.
Speaker 2:And so you have a patient oftentimes will come into a physician sort of interaction and they'll know as much as the physician you know or maybe even more in some cases, about what's going on with their bodies, and I think really the change here is, you know, the, the physician of yesterday spent most of their time diagnosing yeah, trying to figure out what was going wrong, and the physician of the future will be one that's more like a coach, trying to help patients you know, um live a healthier and better life by relying on some of these diagnostic tools to sort of cut straight to the chase on what a patient needs to focus on yeah, I think.
Speaker 1:I think you hit the nail on the head there and um, um, I'm excited for the future. I'm glad we're going through this evolution in my lifetime. I'm 51, so so I know I'm headed towards the cliff.
Speaker 1:I'm just trying to slow down the car, the speed of it, and I really want to thank you for taking the initiative to put your time and effort and money into building a company that really, to me it already has changed the paradigm. But for many will change a paradigm whenever they're ready, mentally ready, whenever they get over themselves and get over their opinions, their strong opinions they have, which is guided by some groupthink or whatever bias they have, and I think I don't. I hope that they won't find out when something bad happens to their health. I hope people can realize the value of it. And you know I always joke about that people. You know, when we go on vacation I love people watching and I'm always thinking like, wow, like this family of four came and spent like ten thousand dollars to go to, like you know, example, disney yeah and then uh, how much?
Speaker 1:how much is a scan, for example? How much do patients pay for a scan?
Speaker 2:twenty five hundred dollars.
Speaker 1:So twenty five hundred dollars for the knowledge. It's a scan, the knowledge of what's going on inside your body. I mean, I can't put a value on it personally. But then you compare that to a vacation that is over in four days, that the money is gone, the vacation is gone, everything. You're going back home, you just spent $10,000. You're going back home, you just spent $10,000. But then, when it comes to their health, they start being very frugal and they just say well, I already pay for insurance, so if insurance doesn't cover it, I don't do it. And that is the kind of um to me. Um, what, what, what has to change and it will change. Once more people do it, more doctors talk about it, where it then becomes normalcy, and right now people think it's only for the rich and the famous.
Speaker 2:But, um, I believe or they think it's uh oh, they think it's for people that are really into longevity and I think you know everyone who's into longevity does one of these scans. But you know, our average patient is just an average person, you know, like they just had grandkids and they want to make sure they're around for you know, as many years as possible.
Speaker 1:Well, when it comes to longevity, you're right. But you have a generation that is dying. So you have the baby boomers. It's probably much harder to convince a baby boomer because they're just too deep into the system as far as belief. But then you have my generation, with the Generation X, they really are on the longevity bandwagon. And then you have the millennials and the Gen Z-ers that are highly aware.
Speaker 1:I know that because they come to me. They ask me hey, what can I do now to slow down or prevent aging? I'm like you're 25. Just enjoy your life, just live a healthy life, do all these things sleep, exercise, nutrition, diet and mindfulness and you should be fine. Don't come here shop for Botox. You don't need that. You just need someone to educate you how to live. And they're like oh, I already know all that. I meditate, I eat only whole foods. I'm like, wow. And so that's the power of social media and the internet that the generation like, especially the Gen Z-ers. They're the smartest and a lot of millennials. By the time they will be ready to get an MRI scan. To them it's going to be as normal as walking into I don't know Starbucks getting a coffee, and I think that's something that, if I was Pernuvo, I would be excited about knowing that the coming generation that is more so. Um, a customer is super intelligent intelligent, educated and proactive when it comes to anything in their lives yeah you know, well, yeah, I'm excited.
Speaker 2:I'm just excited that more people are thinking about this and um, we've been helping thousands of people so far with life-saving diagnoses, and it's a cool space to be working in.
Speaker 1:So what are you working on now?
Speaker 2:Speeding up the scan, making it more comprehensive, opening up new locations. We have 17, in the US, we're opening another 10, or us we're opening another 10 or so year we're opening internationally in europe and australia next year.
Speaker 1:How do you gauge the speed of opening new centers? Um, you know, because you know there is an art and I mean you're, you're obviously a master in business and there's an art between opening make sure you don't expand too fast and stretch yourself thin versus not too slow and missing out on opportunity. How do you balance that?
Speaker 2:well, I think the idea is you're always a little bit over your skis. The goal is to make sure you don't fall over. Um where, look that? There's great private market fit for what we're doing. People want us to enter new markets. There's a lot of pull for that, and so sort of some of the best signal that we have is just when we think we're going to go into a market, we run wait lists and you know we have thousands, sometimes tens of thousands, of people that are waiting for us to enter, and so that's probably as much science that goes into it. If I'm being totally honest, uh, and we just have I have a team that works just tremendously hard trying to help people get the courage to come in and really stay on top of their health amazing, amazing.
Speaker 1:Well, thank you so much for all you do. I can't wait to see this becoming normalcy and I really appreciate you taking the time to come on. I know you're super busy and I promised Andrea and Grace to keep it at one hour and yeah, so hopefully we get to do next year or so another podcast and new developments and I'm personally excited. I'm excited to have the opportunity to, just for myself and my family, for you to have given us this opportunity and yeah, thank you.
Speaker 2:I appreciate it. It's been a great conversation. Thanks for having me, Dario.
Speaker 1:Thank you, I appreciate it. It's been a great conversation. Thanks for having me, dario. Thank you so much, and Andrew Lacey, everyone. The CEO of Prenuvo, and if you have any questions or comments, don't forget to put them on Spotify and I will put out Andrew's information onto the comments and caption section of this podcast. And what's the best way if someone wants to get in touch with you? Andrew's information onto the um comments and caption section of this podcast. And what's the best way if someone wants to get in touch with you. Andrew, you know what's the best way. If someone wants to learn more about it, what do you would you advise them to go to and refer to?
Speaker 2:So, yeah, if they go to our website, actually there's a lot of information there, so that's probably the best starting point. There's a lot of information there, so that's probably the best starting point. Uh, there's a chat feature there where they can speak to one of our um consultants. That can help people understand whether the test is right for them and, uh, and if they prefer to if they're old-fashioned, they prefer to speak to someone. There's we. We actually have a phone number on our website, unlike most other websites, where you can call in and have a conversation with a human. Wow, again, just to make sure that the scan, you know, ask whatever questions you might have about your personal medical situation and, um, and uh, get some clarity about whether the scan's right for you so there's a few ways to reach out wonderful and for our listeners.
Speaker 1:Um, thank you for um providing us a discount code. Um, we'll have a discount code into the caption section of this podcast If you're interested in getting your Prunuvo scan in your local town. You know there's 17 now in the US, as you heard and you know. Yeah, take advantage of it and thank you very much, andrew.
Speaker 2:No problem, thanks, dario.