Live Long and Master Aging
The Live Long and Master Aging (LLAMA) podcast is a weekly series of extended, one-to-one interviews, about human longevity. Hosted by Peter Bowes, leading scientists share their latest research into living a long and healthy life. We delve into the clinical trials and challenge new ideas. We also feature some remarkable people who have already mastered the art of aging. Hear about their insights into growing old, without feeling old, and the secrets of their longevity.
Live Long and Master Aging
The case against full body scans | Dr. Mirza Rahman
Much of the buzz around full body MRI scans has resulted from attention given to them by influencers and celebrities who have posted about their experiences. At a cost of up to $2,500 the scans are touted as a way to catch medical problems, such as cancer, at a stage when they can be treated. But they have been widely criticized by professional medical bodies and are generally not covered by health insurance.
This video is a response by the president of the American College of Preventive Medicine, Dr. Mirza Rahman. He argues that there is no medical evidence supporting the use of such scans which, he says, come with many risks.
In this interview, Dr. Rahman spells out his concerns and challenges companies like Prenuvo to provide evidence, based on peer-reviewed clinical research, that patients stand to benefit from such scans.
Watch this interview at YouTube | Read additional show-notes
BACKGROUND
To learn more about the process and follow-up protocol host Peter Bowes recently accepted an offer to experience a full body MRI scan, provided by the US company, Prenuvo. He later discussed the procedure, related issues and efficacy concerns with the firm's founder and CEO, Andrew Lacy.
Watch the interview with Andrew Lacy at YouTube
DISCOUNTS
This site includes affiliate links from which we derive a small commission, if you click on the product links and use the code LLAMA at checkout. This helps support the channel and allows us to continue sharing conversations like this. LLAMA is available, free of charge, wherever you get your podcasts. Our mission is to explore the science and lifestyle interventions that could help us live longer and better. Thank you for your support.
▸ Algae snacks? To get a 20 percent discount on EnergyBits.com products use the code LLAMA at checkout
PartiQlar supplements
Enhance your wellness journey with PartiQlar supplements. No magic formulas, just pure single ingredients, like NMN, L-Glutathione, Spermidine, Resveratrol, TMG and Quercetin.
Get a 15% discount with the code MASTERAGING15 at PartiQlar
Welcome to the Fit, Healthy and Happy Podcast hosted by Josh and Kyle from Colossus...
Listen on: Apple Podcasts Spotify
The Live Long and Master Aging (LLAMA) podcast, a HealthSpan Media LLC production, shares ideas but does not offer medical advice. If you have health concerns of any kind, or you are considering adopting a new diet or exercise regime, you should consult your doctor.
We want to make sure that the people in this country are able to live long, happy, healthy lives. Healthy People 2030 talks about improving the quality and length of people's lives. So we all have the same goal. We're not at odds over that. What we may disagree on is the substance of the matter, which is, yes, MRIs are safe. Yes, they are effective at addressing specific issues. But what you're talking about is something that is completely different than the way in which these scans were meant to be used. They weren't meant to be used as full body scans. The various risks that are attendant with this need to be addressed. And let's talk about the benefits. If you find these benefits, nobody would be happier than us to get patients to a point where they can use this in a safe and effective manner to have a long, healthy life.
Peter Bowes:Is it worth having a full body MRI scan to screen for early signs of medical problems? Hello again, I'm Peter Bowes, welcome to the Live Long and Master Aging podcast. In our last episode, I told the story of my experience undergoing an early screening scan. I spoke to Andrew Lacy - the founder of a company called Prenuvo - who explained why he decided to build a company that offers people a full body MRI scan as a tool to catch potential conditions, such as cancer, so that they can be treated early.
Andrew Lacy:I went and did that scan, the same scan that you did, last week and, sat down afterwards and went through every single organ of my body. And I felt like I was meeting myself for the first time. I learned that there was nothing crazy serious that was happening under the skin. But I learned a lot of practical information about how I can make small adjustments to my lifestyle that hopefully will change the trajectory of my life. And as soon as I went through this process myself I sort of fell so in love with it that I just wanted to work harder, even still, to bring this to as many people as possible and that, you know, the fruits of that labor is Prenuvo. And the clinics that we're building across North America.
Peter Bowes:There is strong opposition to such scans from medical bodies, including the American College of Radiology, which says there isn't sufficient evidence to justify recommending total body screening for patients with no clinical symptoms, risk factors or a family history suggesting underlying disease or serious injury. In this episode, I want to explore those arguments further with doctor Mirza Rahman, the president of another professional body representing board certified physicians, the American College of Preventive Medicine. Doctor Rahman, thank you very much for joining us.
Dr. Mirza Rahman:My pleasure, Peter, thank you for having me on.
Peter Bowes:And before we dive into this issue, I just wanted to ask you about your organization. You represent over 2000 physicians and other health professionals. What is the main purpose of your organization?
Dr. Mirza Rahman:The American College of Preventive Medicine was set up 70 years ago. We just celebrated her 70th birthday at our annual meeting in Washington, DC last April, and this organization was created to help to improve the length and quality of life here in America. What we do is we have, as you said, about 2000 physicians who are board certified or in various stages of training and preventive medicine. And these physicians are the ones who work on a population based level. So the difference is when you go see your family doctor, she or he takes care of you in the room. When a preventive medicine physician is at work, she or he is caring for a population. It could be at the state level, it could be at the national level. These are the physicians who were primarily at large agencies, whether it's a state health department, a county health department, or organizations that we're all familiar with, like Centers for Disease Control and Prevention or the Food and Drug Administration. So the preventive medicine physicians have that responsibility for a broad group or broad population groups. And so that is what we do.
Peter Bowes:Would you like to see more emphasis on preventive medicine here in the United States? Indeed around the world.
Dr. Mirza Rahman:I think around the world, we would love to see more starting, of course, here in the United States. Unfortunately, a quirk of funding the preventive medicine, residents and residency training programs are not funded like all the other residency programs. So when you think of family medicine or surgery or OBGYN, these are funded through Medicare and preventive medicine, unfortunately is not. It is something we have been lobbying Congress to change. We need to get more preventive medicine-trained physicians out and working. There are lots of folks who want to come and do this work, but you don't have we don't have the requisite funding to do this. And, you know, you talk about having more preventive medicine physicians. That's really vitally important because as we saw with Covid, diseases don't respect borders. And so you don't need a visa to come in. You're British. I was born in Guyana in South America. It doesn't respect borders. And so we need more of these types of physicians. And unfortunately, almost every time we go and talk to politicians to try to get them to support this, this is not changed. And it's something we need to continue to do. It needs to be a fundamental transformation of how we fund and develop the field of preventive medicine here in the United States.
Peter Bowes:And what is your own personal experience as a doctor? And maybe without going through the full biography, just give me a sense of what's brought you to this point in your career.
Dr. Mirza Rahman:Sure, I've done maybe three different things if I think about it. I've worked initially in public health. I was a medical director of a community health center in Long Island in New York. Subsequent to that, I went over into academics, and I worked for a while at Case Western Medical School as faculty in the Department of Family Medicine, and also epidemiology and biostatistics, before leaving about two and a half decades ago to join the pharmaceutical industry, where I've worked at a number of companies, primarily in pharmacovigilance, which is just a fancy word for saying drug safety. So I've worked in that area, and that actually ties nicely to what we will be talking about. It's doing an assessment and an ongoing basis of the benefits and risks of the drugs or vaccines or devices that we work in. And as part of my professional engagement, I've been engaged with the American College of Preventive Medicine since I was a resident at the Stony Brook University School of Medicine in their preventive medicine residency, all the way back to 94 or so. It's been a while.
Peter Bowes:So let's dive into this subject then. MRI scans, magnetic resonance imaging. These are scans that have been around and have been widely used in medicine for a very long time, but there has been in recent years, an undeniable surge in interest in them as a screening technique for people who don't have any previous symptoms, or indeed, a family history that could suggest the that there are potential problems. Now, you have written about this extensively on your organization's website, and it is very clear that you and many others believe that these are not an appropriate form of screening for otherwise healthy people. Let's just start at the beginning with your initial reservations and thoughts about the way in which these scans are being used.
Dr. Mirza Rahman:Well, when this first came up about nine, ten months ago with an influencer who talked about this and got a lot of media coverage, we had gone back in August of '23 and looked at this, and I wrote an article in our newsletter talking about health care, Too Much and Not Enough. Going back to the 1930s, there was a report on the challenges with the delivery of health care in America. And in that report it was stated that the wealthy got too much of it and the poor didn't get enough of it. Gets again to issues of health equity. And yes, while we can talk about anecdotal benefits and patients who have benefited from this, as I talked about in preventive medicine, we look at a population health basis. Does this work for the population and does it work on several levels? And what are the risks of these types of body scans. And this is what we don't hear enough about from the purveyors of this. And, you know, maybe, to be a bit controversial, but maybe not to be too harsh, these purveyors of these types of scams, they not only don't talk about the risks, but they sell lots of potential benefits. And in many ways, I think of these as this century's equivalent of last century snake oil salesman. You're talking about things that have no proven benefit on a population based level. I'm not talking about individually. You can always find the individual who has had something found on a body scan, but if you look at it from a cost effective standpoint, if you look at it from a benefit risk standpoint, what is the evidence? Is there any evidence these companies, the one you mentioned has been around, I think for the last six or so years, I think 2018, they came up. Have they generated any evidence that can be reviewed to show that there is a concrete benefit on a population level for what they're doing, or is it simply a way to generate revenue? Who is this targeted to? Is this targeted to the general population or the population that we refer to as the worried wealthy, well, white individuals who have money to dispose. And they get back to that 1930s statement that the rich get too much of health care and the poor don't get enough.
Peter Bowes:You've covered a lot of, as you describe them, potentially very controversial issues there. Let me focus on risk, which you talked about, and the the lack of discussion about risk. As you see it. What are the risks?
Dr. Mirza Rahman:Let me take just a minute to give you a primer on epidemiology. And when we talk about risk, there are six things we should think about. What is the sensitivity of the test? Because we know disease doesn't occur randomly, right. If you're going to talk about heart disease, for example, do you smoke? Do you have a family history? Is your cholesterol elevated? Do you have diabetes? Are you sedentary? Things happen. Disease occurs in a non-random way. You have to have certain risk factors. And the purveyors of these MRI body scans are saying you should come and get a body scan, and the more is better, right? Let's do it every six months. I saw somebody at one of these companies talking about doing more of it. What are the attendant risks? So sensitivity says a test when done if positive that is the sensitivity. So 90% of the time 97% of the time you do a test and it's positive you will have that disease. Specificity says if you test and you don't have the test is negative, then there is a 90%. If that's the specificity that you don't have the disease, then we come into the parts of risk that you asked about. If you get a false positive, that's a positive test, when you don't have disease. We'll come back to what that means. False negative is you have a negative test and you in fact do have the disease. And then there are two things that we talk about. Positive predictive value. What is the percent of true - of true positives over all positives. Because remember now you have false positives. And this last point is the one that's important. You need to understand the prevalence that is the underlying level of disease. The higher the prevalence, the better your positive predictive value. But if you're scanning for things that are unknown in the entire body, you're going to have a very low prevalence. You're going to have mostly false positives. You will have thousands of needed follow ups. And when we talk about risk, this is where we get to it. The risk are financial. And maybe if you're wealthy and you're going for these tests it doesn't matter. Right. But these are expensive tests to begin with and you may need more testing. The additional testing for the false positives, even the true positives. Right. You're going to have to spend more money. You run the risk of injury. You run the risk of significant medical invasive procedures that can lead to complications, morbidity, more problems, mortality even. Right. What about the anxiety? What about the emotional impact on that person and their family when nothing may be wrong with them? You just find something that the radiologist, if you've spoken to them, refer to as an incidentaloma. It's just incidental. It doesn't mean anything. And what about the adverse events? The FDA on their website had about 300 cases of burns with the use of MRI machines last year. And then you get down to that favorite American thing that we have, which is litigation. Are we going to be prepared for the litigation that ensues from these types of things? And then the last thing is for patients, because we talk about focusing on patient safety, are you in fact doing tests then give people a false sense of security that they don't go out and do the hard things, which is, as you point out in your podcast, exercise, sleeping appropriately, eating nutritious foods, de-stressing, having, connections socially and then not using inappropriate substances. So I've had my my MRI body scan that it came out all negative. I don't even need to go for any more tests. I'm not going to go for my mammogram or my colonoscopy. I don't need to check my cholesterol because the doctor said when I did this MRI scan, everything is fine. So you don't do the right things that you need to do to live this long, happy, healthy life that we all aspire to do. And getting more of these types of scans is going to cause potentially more problems, because will they, in fact be increasing the risk of getting cancer? You know, in your podcast you talk about putting patient safety first, right? As long live and Master Aging podcast, you want to put patient safety first. Is this being done or are we lulling people into a false sense of security, where they, in fact may be worse off for never having gotten these scans?
Peter Bowes:So you talk about and you use the word risk in a very broad sense, covering a number of potential outcomes just in terms of risk of having an MRI. Now, clearly people have MRI scans in many situations. They may well have symptoms. It may be an appropriate kind of scan based on what their doctor has observed about their current condition. And for and you tell me, for the vast majority of people having an MRI scan, just having the scan is I mean, you talked about the potential for burns in a, I think, a small number of people, but generally an MRI is a safe procedure.
Dr. Mirza Rahman:There is no question that an MRI is a safe procedure, otherwise we wouldn't be doing them. And we do tens of thousands if not millions of these procedures. I'm a runner. I injured my knee once, so I've had an MRI of my knee. That is focused medical care that is not screening from head to toe with an MRI. So think of the difference between a problem that needs to be addressed, a knee injury, versus a total body scan. The amount of radiation is entirely different. Correct. Because you're not focusing on one area and then you're not addressing a problem. You're using it as a screening tool. That is. Up to now I have not seen any evidence. You know, I've worked for the last, as I said, 25 plus years in the pharmaceutical industry. And for us to bring products to market, we need to prove that they're safe and effective and MRIs are safe and effective. Otherwise they wouldn't be on the market. The FDA would not approve them, but they're safe and effective when used as directed. So you're looking at a problem. These companies that have been around the one you mentioned for about the last six years, what evidence have they generated to show that full body scanning is safe and effective? Has that data have those papers, if any, been reviewed and published anywhere? Have they been sent to the US Preventive Services Task Force, which reviews these types of things on an ongoing basis? They say, you know, you should get cholesterol screening. You should get blood pressure screening at some point. What is the evidence? And if you're a company purporting that this is a great thing and everybody should get it, and I don't get it, but maybe get it every six months, what is the evidence that has been generated in the last six months to show that the specific use that you're pushing is worthwhile doing?
Peter Bowes:I just want to check that I heard you correctly just now. Did you just refer to the amount of radiation used because clearly MRIs don't use radiation?
Dr. Mirza Rahman:I misspoke, I was thinking of CAT scans. That's correct. Yes. No, no, I was thinking of CAT scans when I said that. But when you have an MRI, it is not the radiation as you know, it's nuclear magnetic resonance imaging. But you do run the risk of burns. And that was in that FDA report that I talked about.
Peter Bowes:So maybe we should just clarify just in case anyone is confused, the difference between a CAT scan or CT scan and an MRI.
Dr. Mirza Rahman:So CAT scans and MRIs are slightly different. They do look at the internal body and without having to do these invasive procedures. But CAT scans use radiation and MRIs Magnetic Resonance Imaging use a different type of waves to get to the visualization that we can see of kidneys, liver, etc..
Peter Bowes:So we're not talking about the dangers of radiation in this discussion with MRIs. And I think it is obviously worth making that clear. Let's talk about one of the the risks that you refer to being false positives or indeed false negatives. Let's just elaborate on exactly what a false positive specifically is and what it could lead to.
Dr. Mirza Rahman:So if you have a false positive, let's sort of move away from, let's say the body scans for a second. Let's do something different. You have 30 year olds and you have 65 year olds. And we could easily do a treadmill test on them. You know, when you're looking to do cardiac testing, right? So you're trying to screen, you could easily say, let's screen for coronary artery disease. Or let's do mammography on 20 year old girls and 60 year old women. The difference is that when you use the mammogram or you, have, the tests for coronary artery disease, the stress testing, if you look at a 30 year old versus a 60 year old, the difference and the likelihood of the prevalence of underlying coronary artery disease is going to be entirely different in those two populations. So while the sensitivity and specificity of the actual test may remain the same, the fact that you have a different amount of disease, we call it the prevalence existing will change the positive predictive value. And because of the testing that you have, you're going to have a lot more false positives, and you're going to require a lot more testing for people who don't need it. So every test that turns out to be positive in the third year old versus the 60 year old is less likely to actually indicate disease. And that's where we talk about the positive predictive value. So you've got a positive test in a 30 year old that is not likely to indicate actual disease. And that's your false positive. But then you still have to undergo potentially more testing. And that's why these things are based on risk screening. Tests are based on risk. Otherwise we could just say, well, everybody should get everything all the time. And without thinking of even the financial constraints of the medical system, how would you be able to follow up on all of those false positives that come forward? And so thinking about this and now looking at it at the MRIs, when you look at the MRIs that you're talking about, full body scan, what is it that you're going to find in 20 year olds, 30 year olds, 40 year olds, 50 year olds? And then just because you find something, it may not mean anything. What does it mean? And even our friends who are the radiologists, they may not know what these things mean. As you start to do all of these things, yes, in time they will get a sense of, okay, that's not an issue or so on, but think of the incremental costs to the to the health care system. And yes, for the most part, I know these things are not covered by insurance. And so people are paying and, you know, it's when we talk about cars and safety, you know, do you drive, do you buy a cheap car because you need to get around or you buy one that has lots of safety features? Well, if you're wealthier, you can afford that, then you can do so. And maybe this is. And I'm not saying people should never do this. This is the United States where you can spend your money pretty much however you want. But does it make sense for you as a patient, as a consumer, to spend your money in this way? Or does it make sense to do the hard work, which is the things we talk about in lifestyle medicine and preventive medicine? Get the appropriate screening things, get the do the primary prevention, eat nutritiously, exercise, sleep. You know, avoid sugar, salt, caffeine, drugs, alcohol and make sure you've got the right social connections. But those things are hard. And we choose not to do the hard things because they are, in fact, hard. When we can spend money and feel, even if incorrectly feeling safe, is what, how we feel.
Peter Bowes:And going back to these false positives. In other words, finding something that eventually, even if there is further testing it is generally agreed isn't a problem. It isn't going to cause you a medical problem in the future. Is it fair to say often referred to as the incidental findings that occur as a result of these MRIs, is it fair to say that pretty much all of us are walking around at any time, at any age, with many of these incidental situations occurring in our body? In other words, there's no time that we are all 100% that you might describe as being fully healthy or normal. There are always going to be these little quirks that ultimately aren't going to be of any significance to our overall health.
Dr. Mirza Rahman:I think that is entirely true. And the more and more we get these types of scans done, the more and more we will find things out that we won't need to worry about. But at first, we will start to worry about them. I think one of the best examples of this right now is when we talk about prostate cancer. In the United States there had been recommendations that have since been changed about screening for prostate cancer, per the US Preventive Services Task Force. And the thing about prostate cancer that we have learned over time is that by the time you get to be 70 and 80, most men will die with prostate cancer instead of having died of prostate cancer. So you have it. It's benign, it's slowly growing. And it doesn't matter because you may have a plethora of other medical problems, including coronary artery disease, kidney disease, etc. but by the time you get to a certain age, we have various anomalies that exist within each of us that won't bother us, won't kill us, but they are there. Could you in fact go about doing everything and chasing down everything? Perhaps you can with enough money, but does it make sense? And how does it impact your health? Does it actually improve your health? Or is this sort of worried, well, going to the nth degree and being obsessive and then dramatically decreasing the quality of their health as a result of ongoing procedures, anxiety, complications and the rest?
Peter Bowes:Let me ask you about the difference between considering this issue at a population level, which you've referred to versus an individual level, because I think this is a part of the debate that some people might find difficult to understand because they are, by their very nature, thinking about their own personal health or the health of their loved ones. If they choose to have a scan like this, they are not necessarily immediately thinking of of the implications at a popular level, the fiscal implications. How would you explain that to someone who is purely concerned about their own health? They maybe have nagging doubts about their health, and they feel as if a full body scan would perhaps help alleviate those worries.
Dr. Mirza Rahman:I think people need to understand that if they're looking for things for themselves, they should also look at the evidence of its utility. You wouldn't necessarily go out and do something that you just heard about just because it's being advertised. And I think that's the danger of this. This is being advertised. It is being pushed by influencers. There's a lot of money to be made by these things. So there is an incentive for the owners of these organizations to push this forward. And even if you're only looking at it for yourself, you wouldn't necessarily do something just because you've heard about it. There still needs to be that discussion with your health care professional, and it's incumbent upon us in the medical field to share with our colleagues the family, doctors, internists, OB-GYNs, etc. the primary care physicians, the physicians that have first contact continuous coordinated care with their patients to get them the evidence to say, look, there is nothing that says this is necessarily beneficial. You can obviously find anecdotal anecdotes about, oh, I went and I found this tumor and if they hadn't done the surgery, this would have been a problem. But if you're somebody going in, you need to understand what are the risks, and the risks are greater than the benefits. And I think if any of these corporations felt that they had great evidence, they would put it forward. In the pharmaceutical industry, I think I may have mentioned, you've got to have two randomized, well controlled trials before you - proving safety and efficacy. Has that been done? Will that be done? Because the trick here is that, you know, that MRIs have been approved. They are safe and effective if used to determine certain things. But this is an entirely new use case that is being put forward for which there is no evidence. And so when you talk about this, you can get anecdotes. And if I'm a patient going in I'm going to talk with my doctor. So Doctor Bose can you tell me, should I have this? The physician, then she or he needs to be equipped and knowledgeable about the risks and benefits of these. So let's say somebody has had coronary artery disease in their family, their smoker or so on, you know. There's something that, you know, you can do a CAT scan to check for coronary calcium. All right. But that's been studied. And that has been proven to be worthwhile to do in certain patients. You're not going to do it in everybody. But if there's certain risk factors, what are the risk factors that somebody that a company can say you should get a full body scan. On what basis is this being put forward? And so as an individual going in to speak with your healthcare professional, she or he should be able to discuss with you. Do you have any risk factors? Are there other things we should do other than the full body scan? And that, I think, is a conversation that takes place with the individual patient in the privacy with their of the office, of their health care professional. And having that discussion is worthwhile. But then bringing in the evidence to support or refute the value of this is going to be important.
Peter Bowes:You mentioned earlier about the societal discrepancies in terms of the use of these scans. You referred to the the healthy wealthy, those people who, let's face it, need to be quite rich to be able to afford something like this. And this isn't something that is being used by America's poorer communities or indeed poorer communities around the world. Is this affecting those communities in a negative way, in that it is being used by the to use the phrase that the healthy wealthy, and that it is requiring all of those follow up procedures as well, which presumably have to be paid for privately because they're not covered by insurance. But my question is, is it doing any wider harm in terms of the health care of every community?
Dr. Mirza Rahman:So I think one thing to be clear is that while the initial testing may be paid for individually, if there is something that is found, then the insurance company to which that person belongs will probably be on the hook. So you are using the resources on a broader level. It's not. It's no longer of me paying for my body scan. I pay for my body scan. They found something on the tip of my right kidney. I take that to my doctor at one of the managed care organizations, and then they are now almost obligated to follow up on that, right? You can't ignore a potential problem. In terms of what this means for the health care system and people who may be socially disadvantaged. You know, we talk about the social determinants of health, people who are in poorer communities, etc. you know, all the health costs are going to rise because of this. And we spend more money than any other country in the world for health. And this will likely cause an increase in this. So, you know, if this becomes used broadly by folks who can afford it. And in fairness, the costs have gone down from about $2500, maybe as low as a thousand may be less than that. But no matter what, if your people are spending money for this, they're finding out things, then these things now have to be investigated. And whether they turn out to be true or false positives, you still have to spend that money. And the US health care bill will go up. And as it goes up, things that we pay for in Medicare and Medicaid, the various managed care companies, all of health care will continue to rise in America. And that then takes away from the ability to care for and provide care for the people who are at the lowest rungs of the ladder.
Peter Bowes:So the, at least one of the big issues here is the lack of research that would confirm that these scans used at a population level, are justified. I'm interested to know how close we are, do you think, to the research being conclusive, so that a majority of health professionals might agree that some element of body scanning, full body scanning for the general population is indeed justified? Utilizing the clearly the advancing technology and scanning technology, which does produce some extraordinary images of the inside of our bodies. Question being how close are we to a time when it may be justified to widen the net in terms of the number of people that have these scans?
Dr. Mirza Rahman:I think that's a question best addressed by the people who own these companies and whether or not they're doing any research. So I have no other comment other than that.
Peter Bowes:But from your perspective, you wouldn't want to encourage wider research into these scans to fully justify or otherwise their use. You say the onus is on the private companies who are using the scans.
Dr. Mirza Rahman:The onus is on them. They're the ones saying that this is what you should come and get. I've worked, as I said, at four different pharmaceutical companies. If we want to bring a new drug to market, the onus is on us to prove that these drugs are safe and effective. Similarly, if I'm the owner of a company that pushes, you know, that purports the benefits of body scans, full body scans, what are the risks? What are the benefits? Display it. You've had five six years of doing this. Show us the evidence because we need to remember, just because you can do something doesn't mean you should be doing it. And you can do lots of things without evidence. You know, most of medicine before the last 40 or 50 years was practiced without evidence. It was see one do one, teach one. It was following what the university or your mentor or your guide did. But we need to get beyond that to a point where we use evidence. It was only until, you know, as recently as the 1960s you had to prove the drugs were safe and effective. I talked about the snake oil salesmen of yesteryear. It was only when there was a debacle, and there were people who died drinking and an elixir of sulfanilamide that we had to prove that things were safe. And that was in around 1910. Around the 1960s, you had the Kefauver Act, and you had to prove that it was safe and effective. Let's prove that these procedures are safe and effective, and we would happily recommend them. I think we want to make sure that the people in this country are able to live long, happy, healthy lives. Healthy People 2030 talks about improving the quality and length of people's lives. So we all have the same goal. We're not at odds over that. What we may disagree on is the substance of the matter, which is yes, MRIs are safe. Yes, they are effective at addressing specific issues. But what you're talking about is something that is completely different than the way in which these bodies, these scans, were meant to be used. They were meant to be used, for knee injuries, to stick with the example I used earlier, they weren't meant to be used as full body scans. And so if you're talking about that, the the various risks that are attendant with this need to be addressed. And let's talk about the benefits. If you find these benefits, nobody would be happier than us to get patients to a point where they can use this in a safe and effective manner to have a long, healthy life. You know, we're all looking to try to diminish chronic disease in this country. We're at a point where, according to the CDC, 70% of American adults over the age of 18 are either obese or overweight. Should we be focusing on those types of things, as opposed to these body scans, where you may falsely reassure people that they're perfectly in good health, when in fact they may have significant underlying issues that are not being talked about or addressed.
Peter Bowes:Just one final point on the risks, the many risks that you talked about. And that is the risk of worry and stress because there are false positives and further tests are required. And I've talked to people who have described going to, to quote, hell and back, during that period of time when they had to follow up on those additional tests for people who are considering this and thinking about it and perhaps are of the mindset that, well, yes, I understand those potential risks, but I still want to go ahead anyway. Is it the case that perhaps people might think they understand, but when they actually get to that point and those stresses and those worries actually hit them, that the impact is much greater than they thought?
Dr. Mirza Rahman:Yeah, I'll quote that noted philosopher who said that you think you're well prepared until you get punched in the face. Mike Tyson. We think we may know what will happen when we go for a test, because the assumption is we're fine. But when you find something that little different, growth in the right kidney, all of a sudden your plans of going in and coming out and you're being reassured, you're fine, turn upside down, you get punched in the face, How do you react? And this is where the anxiety and the emotional toll takes its place, not just on the individual patient, but on their entire family. You know, father of four comes home and says, oh, you know, I had this body scan and they said. To have something now on my kidney. What happens to the next X number of weeks until they find out it's nothing, right. And most of these cases will be a lot of nothings. But for that period of time, you've just been punched in the face. And how do you react and what toll does it take? And that is one of the significant risks that we don't hear enough about. It's usually we, you know, people go in you. The stories we hear about that are covered frequently in the news, in various media sources is about the lovely anecdote about somebody went in and if they hadn't done that test, they wouldn't have found this thyroid cancer. And luckily for her, it was biopsied and the surgery was done. And she's perfectly fine now. You don't hear about the tens of thousands of cases that may exist where they found something. The biopsy was done, it was benign, and there's nothing more to do. How many of those cases exist that we don't hear about? And I think this false equivalence that we need to hear both sides is complete and utter nonsense. We should start to tabulate or ask these, ask these companies that are pushing this, what are the numbers? Show us the data. Tell us how many people you had found something about and what was done and what was the outcome. And I think this is where we need to start from, start from evidence based decision making. And you can't make that decision based on evidence if there's a complete absence of evidence. And this is why the onus is on these companies, from my perspective, that they need to do the studies and demonstrate and show the data of what it is that they have done.
Peter Bowes:Having gone through this and I went into this very open minded and I would say and not going into all the details, but I would say I'm in that group of people that, yes, there were incidental findings, that there was nothing, at least that was observed in the scan, that was potentially a very serious condition for me. But there were incidental findings. Speaking as a 62 year old, that's what you would expect. That's what my doctor expected. That's what happened. I've chosen not to follow up in future tests, any of those situations because I don't. And again, having spoken to my doctor, don't consider any of them to be serious. That is my personal decision, and I guess I'm lucky in that respect that I'm an otherwise healthy human being. There was one impact on me that was was notable and that was having. And I guess other people will experience this as well. Those that are told that, well, look, there's potentially nothing serious, seriously wrong with you. And clearly that isn't 100% conclusion because it could have missed things. But that being the conclusion, there is a sort of feel good factor there that oh, I'm doing okay if I continue with my healthy lifestyle. Maybe it's an impetus to continue with your your healthy lifestyle. But just leaving that aside, one thought that has gone through my mind since going through this is that I just wonder if an equivalent amount of money was spent on health education. And as you've referred to what I talk about a lot is diet for your good health, exercise especially, good sleep, social connections. Those are the the key pillars of longevity for me. If an equivalent amount of money was spent on health education to promote those pillars of good health, to what extent could we improve population health if people took heed of those kinds of factors?
Dr. Mirza Rahman:But I think, Peter part of the challenge. So first of all, let me go back and say, look, I'm glad to hear that you're doing well. And that must have been a scare. And I think if you multiply that through the thousands of people who go through these scares, for every one that you find something that's real, it's got to be, you know, assessed and recognized that this is a risk. And when we talk about education, you know, you've got the American College of Preventive Medicine puts forward lots of things. The American College of Lifestyle Medicine, which for the last 20 years and has grown significantly in the last ten years, they put forward a lot of these things. Much of it can be accessed freely by consumers, patients, etc. but it comes down to the hard work. The hard work is changing behavior and I am as guilty as anyone of it. So I run and and I do other things, stay socially connected, but I know that I don't eat as well as I should. I know that I don't get as much sleep as I should, but that's the hard part, right? And while, you know, President Kennedy talked about when they were looking to go to the moon, we choose to do the hard things because it helps to organize our resources, and we'll get to the moon by the end of the decade. We in this country and around the world find it very hard to do the hard things.
Peter Bowes:We do. That's a really, really good point, but I think it is up to those health professionals working, especially in preventive medicine, to create the environment perhaps that makes it just a little easier to do the things that most of us find hard to do. And you're absolutely right for all, for all. I talk about these things all the time. I'm not perfect either, and I will not eat the perfect diet. Maybe not get as the correct number of hours of sleep that I really need and would like to get. There are always areas where we can improve, and I think the challenge for people, not just people that talk about it like me, but the people who are actually helping us with the professional advice is to keep pursuing that. This is a slow journey, isn't it, in many respects, to to get people to understand the things that are absolutely the best for us. And as I often talk about in terms of medical research and health research, it doesn't happen overnight. And especially when you're dealing with with populations and studies and clinical trials. I guess we're all in this for the long game.
Dr. Mirza Rahman:It is. And I think perhaps one of the things I was listening to a book I had to drive back from Virginia yesterday. I was listening to a book. And really, if we start with the end in mind, recognizing no matter what we do or how healthy we are, we will all die. And I think the Stoics talk about this. So knowing that we will all die instead of having it to the back of our brain, maybe bringing it forward and having it more in the front of our brain, and then trying to do everything we can to maximize our quality of life and our length of life. And the way we do that is by those six pillars that we talk about in lifestyle medicine, and the way we also need to think about doing it, is to be better today than we were yesterday, and to be better tomorrow than we are today in pursuing these six elements of lifestyle medicine. Eating nutritious foods. I'm not saying you need to be vegan, I'm saying you need to eat more fruit and vegetables. Exercise. You don't need to run a marathon, although that's fine if you do. But if you go out walking for 30 minutes a day and so on and so forth. So these are the things if we think about, yes, we will die, but can we put that off for as long as we can and have an avoidance of chronic disease and stay healthy and active and independent and dance at our granddaughter's wedding? Maybe those are the things that we will look to do, and how we get there is to be better a little bit every day compared to the day before, and look to work on these six pillars, and that will help us in the long run, as opposed to looking for what we love so often in America, and maybe around the world, is we look for the quick fix, quick, simple fixes. You know, I'm going to have my steak and I'm also going to take my statin because, you know, that's what we do.
Peter Bowes:Doctor Rahman, this has been an enlightening conversation, hopefully very helpful to people considering this issue. Thank you very much indeed.
Dr. Mirza Rahman:Thank you very much, Peter, I appreciate it.
DISCLAIMER:This podcast is for informational, educational and entertainment purposes only. We do not offer medical advice. If you have health concerns of any kind or you are considering adopting a new diet or exercise regime, you should first consult your doctor.
