Kim Kardashian sparks debate on the benefits of full-body MRI scans

The last time Kim Kardashian posted about medical imaging, it was to prove her butt was real. Now, she’s praising its ability to find aneurysms and cancers before they turn deadly.

Kardashian’s Instagram post this week about Prenuvo, which sells full-body MRI scans that can run in the thousands of dollars, has renewed a long-running debate about whether the tests are actually valuable or just run the risk of clogging hospitals with false positives and unnecessary follow-ups from wealthy and largely healthy patients.

Redwood City, Calif.-based company Prenuvo charges anywhere from about $1,000 to $2,500 for scans, which the company says can detect conditions like spinal degeneration, tumors, potentially treatable brain aneurysms, and musculoskeletal conditions. Prenuvo is one of a growing number of companies, along with Ezra, Neko Health, and SimonMed, offering the elective full-body imaging.

These companies, backed by big-name tech investors and celebrities like 23andMe co-founder Anne Wojcicki and supermodel and actress Cindy Crawford, argue that developing the technology and gathering more scans will make them better, cheaper, and less likely to trigger false positives.

“All technologies need to start somewhere, and technologies generally start very expensive,” said Emi Gal, CEO and co-founder of Ezra. The startup, which uses AI to analyze the images, thinks it can drive prices down to below $500 for a single full-body scan in the next two years if technology can speed up the process.

There’s a significant amount of money flowing into these companies. Launched by Spotify co-founder Daniel Ek, Neko Health raised $65 million this year, with backers including General Catalyst. Prenuvo raised $70 million in a Series A round last year from investors including Wojcicki, Crawford, and Steel Perlot, an incubator chaired by former Google CEO Eric Schmidt.

Demand is also growing. About a third of Ezra’s 5,000 members are what Gal calls “biohacker” types: wealthy tech professionals who want to take their health into their own hands. But the fastest-growing segment is people who’ve had a recent brush with cancer, often a recently diagnosed friend or family, he said. While they’re also relatively well-off and able to pay out of pocket, “we are seeing more market adoption beyond the original kind of biohacker,” he said. Gal said Ezra saw an “abnormal” increase in sign-ups following Kardashian’s instagram post.

Neko Health, which built all its hardware in-house, has scanned about 1,000 people and has about 11,000 on a waiting list — most of whom are referrals from people already scanned. Hjalmar Nilsonne, co-founder of the Swedish preventive health tech company,  said the company can charge as little as 250 euros per scan because it uses low-cost sensors and proprietary devices. Ezra offers full-body scans for as much as $2,350, or single organ scans, like lungs or prostate, for about $750.

Each boast stories of customers who found a troubling problem in an elective scan that traditional health care providers had missed, like the young Ezra patient complaining of back pain only to find out he had kidney cancer, even though a previous ultrasound came back clear.

There are exceptions. But radiologists have been sounding the alarm on the dangers of overtesting for decades; the debate even made an appearance as a small plotline in the TV show “Scrubs.” While MRIs can pick up legitimately threatening conditions, they also pick up abnormalities that are completely benign. Patients then spend time and money seeking more invasive tests, panicking about something that never would have harmed them in the first place.

Kardashian is not the only celebrity touting full-body scans. Saurabh Jha, a radiologist at Penn Medicine, went head-to-head with Mark Cuban on the topic in 2015. Jha firmly believes that offering healthy people full-body scans is medically unnecessary, and can cause more harm than good. But if people decide to spend their money on it, he doesn’t see a point in stopping them.

“If I put my physician cap on, then I realize that this is all just humbug, bordering on quackery,” Jha said. “But then I have another cap, which is sort of a libertarian cap, which is that people can do whatever the hell they want with their organs and their money.”

Unless these companies run large trials showing clinical benefit, insurers won’t cover these scans anytime soon. But Jha said their proliferation might lead to more patients seeking scans based on minor symptoms. Imaging may become more popular, but it won’t necessarily lengthen lives. Still, Laura Heacock, a breast imaging specialist at New York University, said interest in the scans reflects a positive interest in preventative health.

“We are seeing this new wave of people who want to take control of their health, and celebrity endorsements are reflecting this,” Heacock said. “I don’t think they’re driving this.”

Esther Dyson, among the first investors in Ezra and an early backer of 23andMe, said she was initially hesitant, given the obvious questions of who can afford this type of scan.

“My major concern about this thing is I’m not really interested in helping a bunch of rich guys monitor their prostates,” she said.

But she said that the company hasn’t just seen wealthy people — it’s also drawn people who are uninsured, experiencing some early symptoms, and suspect something might be wrong, she explained.

“I’m still concerned about the false positives in general at a time when so many people are being under-treated,” she said.

“Ideally people would be able to make their own calculations. Way too many people just trust the medical system, and many of them are abused by not being taken care of at all. Many are abused by getting too much treatment,” she added.

Assuming companies do eventually prove out that these scans are cost-effective at a population level — which isn’t a guarantee — they could address inequities by reducing costs, working with payers to ensure coverage, offering financial aid, and opening imaging centers in rural and underserved areas, said Grace Lin, a professor of medicine at UCSF who works with its Multiethnic Health Equity Research Center.

While these types of scans “are promising tools to address unmet screening needs, particularly for cancers for which we currently aren’t able to screen for,” these young companies risk “misleading consumers by over-selling the benefits of this kind of screening and minimizing the harms,” Lin said.

Mundane lifestyle changes like eating a plant-based diet and managing stress could go a long way to prevention, but aren’t as alluring as high-tech scans, said Mirza Rahman, head of the American College of Preventive Medicine. And if they trigger unnecessary biopsies they could also lead to physical harm: “Follow-up sounds very benign, but it could be things that could be invasive, or things that cause complications,” he said, like lung punctures or severe anxiety.

While customer anecdotes might be compelling, Rahman said, “if you look at it on a population level, it is not [as valuable].”