Whole body MRI as a present? No thanks!

Well it now seems that if you want to give that VERY special present to a loved one or indeed to give yourself a treat, you can buy an off the shelf whole body MRI scan as simply as booking a haircut. The aim of this, apart from relieving you of cash, is to detect illnesses of which you were not aware and the big selling point of course, to detect cancer early in order to improve the prognosis. 

One provider states “Early detection can save lives, and with technological advancements, you can now get the answers you need and knowledge about your health. You’re in control.”

Why then would I not buy this for anyone, get one for myself and indeed why I think it’s a bad idea. 

Note they do not say “early detection using MRI saves lives” or “This scan detects X% of X type of cancer, or indeed, how many of the scans are totally normal and what the outcomes are for those with abnormal findings? So instead of putting you in control (Brexit jargon again!!), there is a risk of causing you harm.

In the USA this has come to some prominence with the news story of an individual whose brain cancer was detected and successfully treated after a whole body scan she bought. 

It reminded me of how compelling personal stories can inaccurately highlight medical issues – take heart wrenching stories of children with autism diagnosed after vaccination, contrasted against the rather more rational presentations of research showing solid evidence why vaccines certainly do not cause autism.

So here we have a story of woman whose life has been saved by surgical treatment of brain cancer revealed by a whole body scan. Why am I still not convinced?

For one thing, the story is a little odd. The lady in question is an alternative health practitioner and was diverted her from her “natural health” background and belief in the frankly whacky “Terrain theory” (this suggests that your inner environment is the cause of your illness, not microbes) to invest in some very high tech ‘unnatural’ medicine.  The question which was not asked by the reporter was why the scan and why then? 

In my experience people can sometime feel there is something fundamentally wrong with them before specific symptoms emerge.

Who knows? I’m delighted she is well, but not so delighted at the message that such off the cuff screening is a good idea for anyone worried about their health. An infomercial if ever here was one! 

If she or anyone else feels something is wrong, seeing a doctor is a much better idea. If you feel there is nothing wrong with you, then why have a scan at all?

Commercial whole body MRI’s take less time than the focal MRI scans ordered when symptoms are being investigated, are often reported by recently developed AI, not targeted to any specific area of concern or risk and will cost the punter-patient between £1,000 and £2,000. Why scan the knees of someone with a cough??

Screening for any illness in people who are well needs to be carried out carefully after relevant research to establish that more good is done than harm. Screening for cervical (swab)and breast cancer (mammogram) and for colon cancer (microscopic blood in stool), amongst others, have passed these tests, but randomly looking anything that shows up on a whole body MRI? Really??

Screening of all kinds creates harm, not only the procedures themselves but also the possibility the screen misses something significant and falsely reassures, that it diagnoses something that isn’t there, creating much anxiety and the need for more tests, or that it diagnoses something best left alone. Each scenario comes at a price as well as the resultant uncertainty, anxiety and fear with all the implications for health. Care needs to be taken to ensure they do more good than harm.

Commercial whole-body screening fails on all these points. Radiologists to interpret scans are a scarce resource, indeed it would be unethical to divert their time from people who are being scanned for defined problems. The in-house AI systems often used to examine private scans are not validated and quality control is at best uncertain. So you don’t have any idea about the procedures’ rates for false positive or negative results and whether, once scanned, you will be followed up in any way.

So what happens when you book one? I went through the booking procedure at one of these burgeoning MRI providers using my spellcheckers interpretation of my name, Dr Banana. The system only asked the usual MRI related questions – fits, metalwork etc, and none related to why you may be having the scan, for example, are you a smoker? (MRI’s are not much use for screening for lung cancer which is why the NHS lung cancer screen uses low dose CT scans) Are you bleeding from anywhere? Are you worried about anything??  Do you feel unwell?? Indeed anything that might lead to the sensible advice – “you’d better see your GP”. 

Instead of this, you will get a whole body scan if you ask for one, and particularly for the elderly a list of incidental abnormalities we elders accumulate which will then be on your mind and may never cause problems.  

When you then turn up at your GPs with the results showing a lump here or a bump there, the results may, or may not be needed to be acted on, so over to the NHS with all its stresses to sort things out. It’s one thing to have a private scan, another to need blood tests, further imaging, biopsies, histology results, and the waits in between to arrive at a diagnosis of something which was causing no problems, never mind the support and help you need to get through all this.

Even with a simple screening, controversy exists. With prostate cancer screening with a blood test (PSA), issues arise regarding how many benign or slow growing cancers one needs to biopsy to actually detect one where early treatment actually makes a difference. There is also the opinion that mammograms getting less useful as women are better at presenting with breast lumps, treatment is so much better and early presentation of very small cancers is balanced by the fact that some of them may simply disappear without treatment or are very slow growing, giving time to treat them later in their history if needed.

Then there is the issue of how often to repeat the screening scan? The answer to this is no one has the foggiest idea.

So even the simplest screening is fraught with issues of balancing good versus harm and MRI is no exception, indeed, given its scope, could leave you with a list of problems which may or may not be a good thing to be aware of.  This study of volunteers in Korea hinted that WB MRI can be useful at detecting problems; they found about two per person, but most were not problems that needed to be screened for, like bulging discs in the spine.

They found one kidney lesion confirmed to be malignant, but no details of follow up the patients so it can’t say if early detection was helpful, or if that patient had any relevant symptoms. That gives a rate of 1:200 of useful results but the numbers are way too small to draw any conclusions. The scan results were also interpreted by three radiologists, which is certainly not what will be available commercially. If they recommend the highly impractical implication of scanning all their 55 year olds, interpretation would have to be done by AI, and thats a whole new issue.

Another recent review concluded:

“Many people attach high value to the incidental MRI findings of disease that “can save lives.” However, there is a need for balance between the benefit and harm of whole‐body screening in asymptomatic subjects. Based on current evidence, healthcare providers should not offer whole‐body MRI for preventive health screening to asymptomatic subjects outside of a research setting.”

Quite. Despite the evidence there seems to be nothing to stop investors setting up MRI clinics, and the anecdotal stories will come out on social media to make them appear life savers, the harms never making the headlines.

Indeed, commercial outfits having invested hugely in their tackle, might not want to do the audits and research which may put them out of business if they are found to be useless or harmful. Indeed if they are an effective screening tool, detecting worthwhile problems in say, 55 year olds, then surely the procedure might be offered more widely and its availability depend not on the depth of your pocket or your level of anxiety.

Lastly, and this is important, the price. The scan will relieve you of £1,000 to £2,000 depending on the service you want. The question to ask is if you put that sum aside to buy something good for your health, a holiday, a gift to make someone happy, something you have always wanted? Other than those with money to waste the answer surely must be yes.  For most of the population this is a sum of money that is not even available.

Back in the real world, I will shortly be having an MRI of my brain and spine, ordered after a discussion with an experienced and knowledgeable MS nurse. The scan will take about 40 minutes and give frankly incredible pictures of my wonderful central nervous system. I’m not bragging – all central nervous systems are wonderful, though some less wonderful than others!! 

This makes sense. Even at my age new signs of damage might mean new treatment. Nonetheless, if it shows slight (or more) brain atrophy it will be a difficult moment and though useful for planning, not something I actively seek to know about as it is not treatable. If I were to pay them to extend the scan, perhaps I could also get pictures of my very ropey, bulging lumbar discs, my squeezed nerves, my slightly arthritic knees or the likely early degeneration of my hip joints, a possible enlarged prostate, slightly thinning bones and so on, things I’d rather not know about until they cause problems.  I can feel well despite all these diagnoses grumbling away in the background where they belong.

Then finally, in a world of scarce resources, the ethics of making available a largely untested screening procedure that is only available to the well off in well of nations more than hints at the chaos of commercialised medicine. In the wider sense, whole body MRI’s for well people are unethical.

So take care what you ask for. Nothing is without risk and if you are worried about your health, then before dishing out on private investigations, go and see your doctor or health professional, their guidance can save an awful lot of worry and a considerable amount of cash. The absolute imperative is to see the doctor as soon as you get symptoms of concern, new lumps in breast, neck or skin, bleeding from just about anywhere, persistent cough, loss of energy or weight or anything that causes you concern. Do not leave it too long!

In other words, if you think you need a whole body scan, you need to see a doctor!