NEW YORK TIMES: The rise of the ‘Just in Case’ scan as US demand for self-funded MRIs and health tests soars

Last year, Thomas Hogan, a Texas software CEO, began to experience gastrointestinal issues. During an MRI scan clinicians discovered what they said was a benign cyst in his spleen; nothing to worry about. Still his discomfort continued.

A concerned friend booked Mr Hogan, 66, an appointment with personalised health startup Prenuvo, which charged $US2500 ($3825) for an additional 60-minute MRI scan. Three days later, he was on the phone with a Prenuvo clinician.

“They said, ‘You need to get in to see an oncologist. It would appear that you’ve got a tumour on your spleen’,” Mr Hogan recalled. It was stage 4 cancer.

Medical tests have become the next frontier of a growing obsession with personal wellness data. Just as wearable devices like the Oura Ring and Apple Watch have made it easy to track once-esoteric stats like heart rate variability and blood oxygen levels, a new batch of US companies allows customers to access tests like cholesterol levels, inflammation markers, gut-microbiome readouts and even full-body MRIs whenever they want them.

Occasionally, as in Hogan’s case, these tests can lead to a critical medical diagnosis. But some physicians warn that overtesting might lead to unnecessary medical interventions.

Regardless of whether or not it’s wise to sidestep your doctor, there’s a lot of money betting that demand for personalised medical testing in the US will continue to grow.

The concept has attracted venture capital backing from the likes of Andreessen Horowitz. Famous entrepreneurs including Daniel Ek, who recently announced that he would step down as CEO of Spotify, and John Mackey, the co-founder and former CEO of Whole Foods, have founded personalised wellness companies. And some employers, including John Hancock Financial, the NBA and the city of Tempe, Arizona, now offer such testing services as a perk.

Offerings and price tags vary widely. Function Health sells $US499 ($750) annual memberships for 100-plus “biomarker” tests, promising clients a digital dashboard of their own biology. (QuestDiagnostics actually conducts the tests for Function.) Prenuvo charges $US2500 for full-body MRIs that aim to detect undiagnosed cancers, aneurysms and other silent killers. Love.Life, a Los Angeles “holistic health and wellness club” backed by Mr Mackey, goes further, with memberships that can reach $US25,000 a year and include blood tests, wellness coaching, yoga, pickleball, acupuncture, reiki and other offerings.

Companies that offer concierge medical testing often explicitly lean into frustration with the traditional health care system in their marketing. But the industry is also the product of what Jonathan Swerdlin, the founder of Function Health, deems “a cultural shift” towards wellness that began nearly two decades ago: Pilates, yoga, saunas, ice baths, ayahuasca retreats, MAHA. The COVID-19 pandemic accelerated the trend.

“Health has left the four walls of the doctor’s office,” Mr Swerdlin said. “But wellness got to a place where it lacked scientific and medical rigour. We’re finally applying science to what people are trying to achieve, which is living a longer, healthier life.”

Critics of turning medical testing into a “choose your own adventure” service argue that too much wellness tracking could actually make you unwell. Even the data from an Oura Ring, a wearable that monitors sleep time and heart rate variability, can send users into anxiety spirals, according to some experts.

“Healthy people are not infrequently turned into patients because of the detection of abnormalities that eventually prove to be false positives,” Dr Thomas Kwee, a radiologist at the University Medical Centre Groningen in the Netherlands, cautioned over email. (In that country, people cannot order diagnostic tests without a doctor’s visit, he added.)

If you look closely enough, almost everyone has something in their bodies that might appear off but is ultimately insignificant — a patch of scarring, a strange growth. Once you become aware of it, how do you proceed?

“Incidental findings of unclear significance often require other, sometimes risky tests like biopsies to resolve,” said Dr Mike Pignone, a Duke University medical professor and former member of the US Preventive Services Task Force. “Or they can’t be fully resolved and thus increase a patient’s anxiety and spending without health benefits.”

Andrew Lacy, founder and CEO of Prenuvo, countered, “We believe the bigger problem is false negatives rather than false positives.”

In the case of Mr Hogan, the Austin software CEO, the cancer that Prenuvo discovered had metastasised into his lungs, spleen, lower abdomen and bones. It was large B-cell lymphoma, an aggressive form. At the MD Anderson Cancer Centre in Houston, Mr Hogan began a regimen of chemotherapy and other treatments.

Now in remission, he is “much more dialled in” to his health, he said: infrared saunas, cold plunge pools, red light therapy. “But the moral of the story is that if I hadn’t gotten this scan, it would probably have been game over for me.”

In Australia, diagnostic imaging and pathology tests must be ordered by an authorised medical practitioner, even if privately funded.