Latest / The Antisocial Doctors Podcast / Episode 9: Should We Be Getting Full Body MRIs?

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Episode 9: Should We Be Getting Full Body MRIs? · The Antisocial Doctors Podcast

• 1:27
  Sonia Singh MD: You are listening to the Antisocial Doctors Podcast, hosted by me, Sonia Singh, a board certified internal medicine physician with a Master's in nutrition and a special interest in health anxiety
• 1:38
  Rebecca Berens MD: and me, Rebecca Barons, a board certified family medicine physician with a special interest in disordered eating.
• 1:43
  Sonia Singh MD: We're also a millennial women anxious moms and curious humans navigating social media.
• 1:48
  Sonia Singh MD: We've seen firsthand how these platforms can be powerful tools for education and connection, but can also make us unwell.
• 1:56
  Rebecca Berens MD: This podcast is meant to be the antidote to your doom.
• 1:58
  Rebecca Berens MD: Scrolling, a, solve for the anxiety, stress, guilt, shame, and confusion.
• 2:02
  Rebecca Berens MD: That comes from social media's messaging around health.
• 2:05
  Rebecca Berens MD: In each episode, we discuss a health related talk trending on social media with curiosity, nuance, evidence, humility, and compassion.
• 2:12
  Sonia Singh MD: This is not your average debunking podcast.
• 2:14
  Sonia Singh MD: We wanna explore not just what is trending on social media, but why?
• 2:18
  Sonia Singh MD: Why are so many people drawn to this?
• 2:20
  Sonia Singh MD: What is the nugget of truth here?
• 2:21
  Sonia Singh MD: What are the facts?
• 2:23
  Sonia Singh MD: What can we learn from this as patients and doctors?
• 2:25
  Sonia Singh MD: No shame.
• 2:26
  Sonia Singh MD: No blame, no snark.
• 2:27
  Rebecca Berens MD: We're so glad you're here.
• 2:43
  Rebecca Berens MD: Hi Rebecca.
• 2:44
  Rebecca Berens MD: Hi Sonia.
• 2:45
  Rebecca Berens MD: How are you doing today?
• 2:47
  Rebecca Berens MD: I'm hanging in there.
• 2:48
  Rebecca Berens MD: How about you?
• 2:49
  Sonia Singh MD: Same girl.
• 2:50
  Sonia Singh MD: Same.
• 2:52
  Sonia Singh MD: Today we're talking about a topic that I've gotten a lot of questions about on social media and from patients.
• 2:59
  Sonia Singh MD: And so I'm really excited to review it with you.
• 3:03
  Sonia Singh MD: Tell us about the story that inspired this episode.
• 3:07
  Rebecca Berens MD: Yeah, so I think we've actually both had this experience where I actually had a patient who sent me their report after having had one of these done.
• 3:16
  Rebecca Berens MD: We hadn't talked about it beforehand.
• 3:18
  Rebecca Berens MD: And I'd heard of these, I'd seen them advertised on the internet, but I didn't really.
• 3:22
  Rebecca Berens MD: Know much about them.
• 3:23
  Rebecca Berens MD: I hadn't really thought much about it.
• 3:25
  Rebecca Berens MD: 'Cause it just seemed to me unnecessary.
• 3:27
  Rebecca Berens MD: But after I saw okay, like I now know people who are getting these done.
• 3:30
  Rebecca Berens MD: I really need to educate myself about what is being marketed, what is being explained to people about these studies?
• 3:37
  Rebecca Berens MD: Why are people choosing them?
• 3:38
  Rebecca Berens MD: How can we help them make an informed decision about doing this sort of thing?
• 3:43
  Rebecca Berens MD: And how can we respond to, I'm sure you've also experienced this, the deluge of ads that we all get for these studies on the internet.
• 3:51
  Rebecca Berens MD: So that's the story that brought me to this topic.
• 3:54
  Sonia Singh MD: So what is the claim around full body MRIs?
• 3:58
  Rebecca Berens MD: Yeah, so I pulled some claims directly from testimonials that I saw on social media and on company websites.
• 4:06
  Rebecca Berens MD: We're not gonna name any names of any companies here, but testimonials that were placed.
• 4:09
  Rebecca Berens MD: And I think important to mention that underneath all of the testimonials and all of the partners they did receive a free scan.
• 4:17
  Rebecca Berens MD: In response or in exchange for their testimonial.
• 4:19
  Rebecca Berens MD: So I think that's just an important good
• 4:20
  Sonia Singh MD: catch note,
• 4:22
  Rebecca Berens MD: To keep in mind that they did receive something for their testimonial.
• 4:26
  Rebecca Berens MD: 'Cause how could you make a testimonial if you hadn't had the scan, right?
• 4:28
  Rebecca Berens MD: But anyway couple things that I saw repeated over and over again in these testimonials.
• 4:33
  Rebecca Berens MD: One of them was this MRI helped me catch this serious medical condition that otherwise would've been missed.
• 4:40
  Rebecca Berens MD: And I was able to treat it earlier and it improved my outcome.
• 4:43
  Rebecca Berens MD: There was one person that claimed they had a cancer that was caught that, and it improved their likelihood of a cure from 20% to 90%.
• 4:50
  Rebecca Berens MD: I was like, that's pretty compelling.
• 4:52
  Rebecca Berens MD: I'm not sure how we are predicting that but compelling sounding story.
• 4:56
  Rebecca Berens MD: Yeah.
• 4:56
  Rebecca Berens MD: And then the other common theme that I heard was this claim of I did this, and now I have peace of mind.
• 5:01
  Rebecca Berens MD: I know that I'm okay because I've done this test, I've had this very thorough evaluation, so now I have peace of mind that I'm healthy and everything's fine.
• 5:09
  Rebecca Berens MD: So those are the sort of like recurrent themes of the claims that I saw.
• 5:13
  Rebecca Berens MD: And then, just in terms of what the actual advertised claims are there's one company that I saw whose claim of advertised benefits was that we are assessing your head, neck, chest, abdomen, pelvis, and legs to look for solid tumors, spine degeneration, and other problems, metabolic disorders, non-cancerous conditions brain aneurysms and autoimmune disorders.
• 5:38
  Sonia Singh MD: Ooh.
• 5:38
  Sonia Singh MD: I have so many problems with this list already.
• 5:40
  Sonia Singh MD: Okay.
• 5:43
  Rebecca Berens MD: So that is actually from the company claims,
• 5:45
  Sonia Singh MD: okay.
• 5:46
  Sonia Singh MD: I think my general gal is that.
• 5:49
  Sonia Singh MD: The advertising for these companies makes you feel like, okay, you're gonna get a really thorough head to toe screening for bad stuff.
• 5:59
  Sonia Singh MD: Yeah.
• 5:59
  Sonia Singh MD: And
• 6:00
  Rebecca Berens MD: anything that's wrong with you, we'll find it.
• 6:01
  Sonia Singh MD: We're gonna find it, and your doctor will never offer this to you, which is an interesting question to explore.
• 6:08
  Sonia Singh MD: But yeah, I think the peace of mind piece is really big for a lot of patients I talk to.
• 6:13
  Sonia Singh MD: 'cause by, if they've already, if they're already talking to me, then they have access to healthcare and they've done a lot of things.
• 6:19
  Sonia Singh MD: And so to them this looks like an added layer of security, knowing that there, everything's okay.
• 6:26
  Sonia Singh MD: But yeah, I would definitely wanna come back to this list at some point when we talk through the facts.
• 6:30
  Sonia Singh MD: Okay.
• 6:30
  Sonia Singh MD: So what do you think, we're already talking about it, but what do you think has made this so viral at this point in time?
• 6:37
  Sonia Singh MD: This
• 6:37
  Rebecca Berens MD: full
• 6:37
  Yeah.
• 6:38
  Sonia Singh MD: Idea of doing a full body MRI.
• 6:40
  Rebecca Berens MD: So we've talked about this ad nauseam on this podcast, health anxiety is at an all time high.
• 6:45
  Rebecca Berens MD: And I think especially with social media, what you do see a lot of on social media is you hear stories of people whose lives were rocked by some surprise diagnosis.
• 6:56
  Rebecca Berens MD: Yeah.
• 6:56
  Rebecca Berens MD: And this horrible thing happened to my family.
• 6:58
  Rebecca Berens MD: You see the GoFundMe, you see these horrible things and you're like, oh my gosh, that would be so terrible.
• 7:04
  Rebecca Berens MD: How can I prevent that happening to me?
• 7:06
  Rebecca Berens MD: And I think we get targeted these stories because they are so emotional.
• 7:09
  Rebecca Berens MD: They, they garner a lot of engagement and so they get shared and the algorithm prioritizes them.
• 7:15
  Rebecca Berens MD: And I don't know, for me in particular, when I was spending a lot of time on Instagram, I got targeted a lot of Instagram widow content.
• 7:22
  Rebecca Berens MD: I don't know if you've ever had this content targeted at you.
• 7:26
  Rebecca Berens MD: Yeah.
• 7:27
  Rebecca Berens MD: I mean there's actually quite a few widow influencers on Instagram and.
• 7:32
  Rebecca Berens MD: Some of them, their husbands had a sur some of it was an accident, but some of them, it was like a surprise health diagnosis.
• 7:39
  Rebecca Berens MD: That came out of nowhere.
• 7:40
  Rebecca Berens MD: And it's you hear these stories and you're like, oh my gosh, how can I avoid that happening to me?
• 7:44
  Rebecca Berens MD: Yeah.
• 7:45
  Rebecca Berens MD: Makes sense that then you're looking for that, the solution.
• 7:47
  Rebecca Berens MD: What is the thing I can buy that will prevent me having to experience that?
• 7:51
  Rebecca Berens MD: I think also.
• 7:53
  Rebecca Berens MD: As we've also talked about many times in this podcast, people struggle with navigating the healthcare system and getting even the basic needed screenings that we do recommend from a public health standpoint and from, our specialty guidelines.
• 8:04
  Rebecca Berens MD: There's a lot of barriers.
• 8:05
  Rebecca Berens MD: You have to, have insurance coverage for it.
• 8:08
  Rebecca Berens MD: If you don't have insurance coverage for you, for it, for some reason, you don't have insurance, you have to pay cash for it.
• 8:13
  Rebecca Berens MD: If you have certain insurances, you have to go through a really lengthy and annoying referral process to be able to access your your screenings.
• 8:19
  Rebecca Berens MD: If you have an HMO for example, you have to go to make sure it's the right PCP and they sent you to the right place and they put the right referral and the right insurance portal, that process alone can take a couple of weeks.
• 8:30
  Rebecca Berens MD: You have to have time to go to these appointments.
• 8:33
  Rebecca Berens MD: For for many people you actually have to go to multiple different doctors to get your screenings.
• 8:37
  Rebecca Berens MD: If you're a female, maybe you.
• 8:39
  Rebecca Berens MD: See a primary care doctor that doesn't do pap smear.
• 8:41
  Rebecca Berens MD: So then you're also seeing a GYN and then you're also being referred to a gi for a colonoscopy, and then you're also being referred over to get your mammogram.
• 8:48
  Rebecca Berens MD: This is multiple days and time of, out, of your life that you have to spend doing this.
• 8:53
  Rebecca Berens MD: So it's just the barriers that people experience and feeling like so much to do on top of everything else that we have to do.
• 9:00
  Rebecca Berens MD: And then I think also when you do finally get to that appointment, you just get okay go do this stuff.
• 9:05
  Rebecca Berens MD: And there's not a whole lot of discussion about it.
• 9:07
  Rebecca Berens MD: It's, and I think people feel like they don't have a full understanding of why am I doing this?
• 9:13
  Rebecca Berens MD: What is the value of doing this?
• 9:14
  Rebecca Berens MD: What do the results mean?
• 9:15
  Rebecca Berens MD: I could see how then you're like, oh, here's this, head to toe exam, we'll find everything.
• 9:20
  Rebecca Berens MD: Yeah.
• 9:20
  Rebecca Berens MD: And you're like, oh, great.
• 9:22
  Rebecca Berens MD: Ignore all that stuff.
• 9:23
  Rebecca Berens MD: Just knock it all out in one day, and then now I have peace of mind and there's, and all the stuff that you couldn't screen me for this also will screen me for.
• 9:29
  Rebecca Berens MD: I think that's, I was gonna
• 9:30
  Sonia Singh MD: say, I think that last piece is a big one because I think with the explosion of all of this, health and wellness information online and on social media, and also just all of this new, I feel like there's this whole, the Medicine 2.0, the medicine 3.0, the biohacking they all have this tone of.
• 9:48
  Sonia Singh MD: Oh, what you're getting in with your doctor, your traditional doctor's office is just barely, you're just barely scratching the surface.
• 9:54
  Sonia Singh MD: There's so much more that, needs to be looked at and tested.
• 9:57
  Sonia Singh MD: And so I think that sentiment has just grown with with social media and the explosion of kind of just access to information.
• 10:05
  Sonia Singh MD: And so people have this sense that yeah, even if you are doing the screenings that your doctor recommended, maybe that's not enough.
• 10:12
  Sonia Singh MD: And as you said, when you're served all this content that makes it seem like everyone around you is dropping dead of some crazy thing that they didn't see coming.
• 10:19
  Sonia Singh MD: I think, being diagnosed with any kind of terminal illness or something really serious is scary no matter what.
• 10:25
  Sonia Singh MD: But I think what's even scarier to people is the idea that I thought this was normal or I thought I had no problems, or I thought I was healthy.
• 10:31
  Sonia Singh MD: Yeah.
• 10:32
  Sonia Singh MD: And then this thing happened, that is terrifying.
• 10:33
  Sonia Singh MD: 'cause then people who are like, I have no reason to believe I'm sick.
• 10:36
  Sonia Singh MD: Suddenly.
• 10:37
  Sonia Singh MD: Are afraid that they might be, yeah.
• 10:39
  Sonia Singh MD: And so I think this prevents, presents like a really, a very simple, viable, clickable, one time in and out solution for that.
• 10:48
  Sonia Singh MD: And before.
• 10:50
  Sonia Singh MD: Before these new companies cropped up.
• 10:52
  Sonia Singh MD: My mom who has terrible health anxiety, would go to India like every couple of years to get her full body scan.
• 10:58
  Sonia Singh MD: I think she was getting a CT, to be honest, but she was very much oh, here, you gotta prove everything.
• 11:04
  Sonia Singh MD: You gotta have so many reasons.
• 11:05
  Sonia Singh MD: And justifications and insurance denies everything, but I, you just go over there and you can get whatever you want.
• 11:11
  Sonia Singh MD: So I just get my whole body scanned and, I think that speaks to this this underlying belief that here everything is just gate kept, and the reason the reasons people are not ordering that for you are not just because they don't think it would be helpful or it may be harmful, or it's just oh, it just costs too much money and there's not enough resources, and the insurance's not gonna prove it.
• 11:30
  Sonia Singh MD: And basically all these other reasons that are not really that valid to the patient from the patient point of view.
• 11:36
  Sonia Singh MD: Yeah.
• 11:36
  Sonia Singh MD: And yeah, I think that sentiment again, since the COVID pandemic and just the general distrust that has arisen towards the medical community, I think that sentiment of oh they're gatekeeping, they're preventing us from getting these screenings that may be helpful because they're expensive or, they're just behind on technology.
• 11:55
  Rebecca Berens MD: Yeah.
• 11:55
  Sonia Singh MD: I think all of that plays into why people jump for this.
• 11:59
  Rebecca Berens MD: Yeah.
• 11:59
  Rebecca Berens MD: Yeah.
• 12:00
  Sonia Singh MD: So what, tell us about what the truth is.
• 12:02
  Sonia Singh MD: What's the negative truth in all of this?
• 12:04
  Sonia Singh MD: What can full body MRIs potentially be helpful for?
• 12:08
  Rebecca Berens MD: Yeah I'll start with just the idea of screening in general.
• 12:12
  Rebecca Berens MD: There, there is a true benefit to screening when you do not have symptoms for certain conditions.
• 12:18
  Rebecca Berens MD: And, there are numerous guidelines that come from specialty organizations and government organizations in every country that.
• 12:26
  Rebecca Berens MD: Have weighed the risks, benefits, costs.
• 12:30
  Rebecca Berens MD: Outcomes, all of that of various screening tests.
• 12:33
  Rebecca Berens MD: And there are tests that we do, even if a person is not having any symptoms to try to catch an illness at an earlier and treatable stage.
• 12:40
  Rebecca Berens MD: That concept is obviously true.
• 12:41
  Rebecca Berens MD: And I think our public health campaigns about this have been very effective at convincing people that they should have screenings.
• 12:48
  Rebecca Berens MD: So like pap smears, for example.
• 12:50
  Rebecca Berens MD: I think everyone is very aware that they should be getting pap smears and that there's benefit to getting pap smears.
• 12:56
  Rebecca Berens MD: Even just a blood pressure screening, blood pressure is, we call it the silent killer.
• 12:59
  Rebecca Berens MD: It's one of the thi those things where you don't know you have high blood pressure until you check it and by the time you're feeling symptoms from the high blood pressure, it's already likely causing you some problems.
• 13:09
  Rebecca Berens MD: And so it's there is this, the concept of screening is true.
• 13:13
  Rebecca Berens MD: There are some things that it is worth going and getting checked even if you feel fine.
• 13:16
  Rebecca Berens MD: So the concept of screening is true.
• 13:18
  Rebecca Berens MD: And for whole body, MRII, I wasn't very familiar with the concept because it's not something that as a primary care physician I'm ever really ordering.
• 13:25
  Rebecca Berens MD: But there are evidence-based guidelines in specific situations for using whole body MRIs for screening.
• 13:31
  Rebecca Berens MD: So I found a a narrative review from the American Journal of Radiology Clinical Applications and controversies of whole body MRI.
• 13:37
  Rebecca Berens MD: And so according to this article, the strongest evidence supporting this was for patients with leaf arm mini syndrome.
• 13:44
  Rebecca Berens MD: It's for adults with high risk high risk of developing malignancy for some children.
• 13:48
  Rebecca Berens MD: So children with malignancies such as Ewing sarcoma, adults with oid lipos sarcoma, pregnant patients with a cult or newly detected malignancy.
• 13:56
  Rebecca Berens MD: So there are cases where whole body screening for cancer may be relevant for some patients in some clinical situations.
• 14:03
  Rebecca Berens MD: There's also some clinical situations that are not for cancer screening, but for other disease monitoring or diagnos diagnosis.
• 14:10
  Rebecca Berens MD: Chronic non bacterial osteomyelitis, myopathy, inflammatory arthritis, and fever of unknown origin were all listed as potential conditions where a whole body MRI may be helpful.
• 14:21
  Rebecca Berens MD: So it's not to say that the.
• 14:24
  Rebecca Berens MD: Idea of doing a whole body MRI is always wrong.
• 14:26
  Rebecca Berens MD: There are some evidence-based situations where it makes sense, but none of these are screening an average risk population.
• 14:33
  Rebecca Berens MD: These are all specific clinical situations, patients with specific conditions or specific risk factors.
• 14:39
  Rebecca Berens MD: And I think that that was new information for me that I actually did not know.
• 14:43
  Rebecca Berens MD: And then I think the other nugget of truth, which we've alluded to is there are a lot of conditions that we don't have specific screening tests for that could potentially be handled differently with a different outcome if we caught them at an earlier asymptomatic stage.
• 15:00
  Rebecca Berens MD: Like pancreatic cancer, for example, is one that I think of where you hear all these stories of people who don't have symptoms of their pancreatic cancer until they have a very advanced cancer that is not treatable.
• 15:12
  Rebecca Berens MD: And.
• 15:13
  Rebecca Berens MD: There have certainly been people who have had incidental pancreatic cancers found at an early treatable stage because they happen to get imaging for some other reason.
• 15:21
  Rebecca Berens MD: I had a patient like this actually years ago.
• 15:24
  Rebecca Berens MD: And it was, it was just, it was remarkable.
• 15:27
  Rebecca Berens MD: I was like, oh my gosh, I've never seen a pancreatic cancer that was treatable.
• 15:31
  Rebecca Berens MD: They had they had surgery and they, and it was resected and they did really well.
• 15:35
  Rebecca Berens MD: And there are these cases, but again, how do we determine who that is appropriate for, and how do we balance the risks and benefits, which is what we'll get into later.
• 15:46
  Sonia Singh MD: Yeah.
• 15:46
  Sonia Singh MD: That's interesting.
• 15:47
  Sonia Singh MD: So it's, it's helpful to know that.
• 15:50
  Sonia Singh MD: Whole body MRI is useful in certain clinical scenarios.
• 15:54
  Sonia Singh MD: It's just clinical scenarios that you and I don't encounter terribly often.
• 15:58
  Rebecca Berens MD: Yeah.
• 15:58
  Sonia Singh MD: Don't apply to, the vast majority of the population.
• 16:01
  Sonia Singh MD: Yeah.
• 16:02
  Sonia Singh MD: And when you're thinking about any type of scan from an, I guess just to educate, the nonmedical listener, it's like there are indications for each and every test, whether it's imaging or labs or whatever.
• 16:13
  Sonia Singh MD: And it's funny, it just, the whole concept of just scanning somebody head to toe with MRI, strikes me as a little like cave manish, it's just yeah.
• 16:21
  Sonia Singh MD: Just scan the whole body.
• 16:23
  Sonia Singh MD: That makes sense.
• 16:24
  Sonia Singh MD: And I think when you hear about, especially, I'm glad you mentioned pancreatic and ovarian,'cause I get questions about this all the time.
• 16:29
  Sonia Singh MD: It's like, how can I screen myself?
• 16:31
  Sonia Singh MD: Can I just get an ultrasound?
• 16:32
  Sonia Singh MD: Can I just, can we just scan it just in case, and I try to remind people if doing these imaging studies periodically.
• 16:39
  Sonia Singh MD: Detected enough cancers or changed the outcomes, changed, mortality changed.
• 16:44
  Sonia Singh MD: If it changed the trajectory of that disease and was able to do that, then there would probably be some screening around it.
• 16:50
  Sonia Singh MD: And so the fact that it, there isn't, it's not just that no one has ever thought why don't we just, why don't we just scan somebody's whole body once a year?
• 16:58
  Sonia Singh MD: It's probably because it's, that's determined to not have those outcomes or to not be worth the potential harms of doing that, which are hard to, I think are hard to really appreciate when you have not had a lot of experience with the medical system.
• 17:11
  Rebecca Berens MD: Yeah.
• 17:12
  Rebecca Berens MD: And we'll get into all of the details on that issue specifically when we get into the facts section.
• 17:17
  Rebecca Berens MD: But to your point about the.
• 17:20
  Rebecca Berens MD: Cave minish.
• 17:21
  Rebecca Berens MD: It reminds me, have you seen the movie Idiocracy?
• 17:23
  Sonia Singh MD: Oh, of course, yes.
• 17:24
  Rebecca Berens MD: Okay.
• 17:24
  Rebecca Berens MD: Where I'm like, okay, so we're actually there now.
• 17:27
  Rebecca Berens MD: That's the point of Idiocracy that we have arrived at.
• 17:29
  Sonia Singh MD: Yeah.
• 17:30
  Sonia Singh MD: Where he just goes in that tube and like all of these things come and they scan his whole body.
• 17:34
  Sonia Singh MD: Yes.
• 17:34
  Rebecca Berens MD: Yeah.
• 17:34
  Rebecca Berens MD: That's, yeah.
• 17:35
  Rebecca Berens MD: So
• 17:35
  Sonia Singh MD: that's
• 17:35
  Rebecca Berens MD: where we are.
• 17:36
  Sonia Singh MD: It's ironic to me that it's it is like this high tech startup kind of vibe,'cause there's nothing high tech about this.
• 17:43
  Sonia Singh MD: They're just like, let's scan somebody, let's just scan their whole body and see what's there.
• 17:47
  Sonia Singh MD: Yeah.
• 17:47
  Sonia Singh MD: So anyway, yeah.
• 17:49
  Sonia Singh MD: The concept is not particularly revolutionary.
• 17:52
  Sonia Singh MD: Yeah.
• 17:53
  Sonia Singh MD: Okay.
• 17:53
  Sonia Singh MD: So tell us a little bit about the facts with a little bit more context and nuance.
• 17:58
  Rebecca Berens MD: Yeah.
• 17:59
  Rebecca Berens MD: I wanna start with the disclaimers from one of these companies.
• 18:03
  Rebecca Berens MD: Their own disclaimers, which are, in the fine print at the bottom of the website.
• 18:07
  Rebecca Berens MD: Really hard to see.
• 18:08
  Rebecca Berens MD: Not front and center, like all of the,
• 18:10
  Sonia Singh MD: of
• 18:10
  Rebecca Berens MD: course, testimonials with all the happy patients who received a free scan.
• 18:13
  Sonia Singh MD: Yes.
• 18:14
  Rebecca Berens MD: But I think this is important and I think is what is not I've never seen really addressed in any of the sort of promotional content that I've seen for these things.
• 18:23
  Rebecca Berens MD: So it is specifically supposed to be an adjunct to, but is not intended to replace other evidence-based screenings.
• 18:30
  Rebecca Berens MD: It may not detect some very small cancers.
• 18:34
  Rebecca Berens MD: It generally can identify cancers once they're approximately one centimeter in size, but it depends on the organ and the appearance of the organ.
• 18:41
  Rebecca Berens MD: And that cancer under MRI, whether it's detectable, even at that size it cannot detect lesions in the lining of body parts, including the mouth, nose, throat, gastrointestinal tract, which is where, especially like colon cancer for example, like you're not seeing big masses initially when you're catching early screenings.
• 18:56
  Rebecca Berens MD: When you get a colonoscopy, you're seeing a small mucosal lesion, you're not seeing a big mass.
• 19:00
  Rebecca Berens MD: As with many tests, there are limitations which may make it impossible to detect all malignancies and disease conditions.
• 19:06
  Rebecca Berens MD: It does not evaluate the heart or heart vessels, which again, when you're.
• 19:10
  Rebecca Berens MD: Imaging the chest, you think my heart's in there, but is it really giving you imaging of that does not evaluate detailed lung micro architecture or pulmonary micro nodules?
• 19:18
  Rebecca Berens MD: So lung cancer is one that's hard to screen for, although there is a screening for it.
• 19:21
  Rebecca Berens MD: But, specific risk factors and guidelines around that.
• 19:23
  Rebecca Berens MD: This is not as good as that.
• 19:25
  Rebecca Berens MD: Established screening method for that.
• 19:27
  Rebecca Berens MD: It does not replace dedicated breast imaging for screening or diagnostic evaluation.
• 19:31
  Rebecca Berens MD: It's limited in evaluation of the GI tract.
• 19:33
  Rebecca Berens MD: Does not replace endoscopy or endoscopy.
• 19:35
  Rebecca Berens MD: Limited in assessment of large joints.
• 19:38
  Rebecca Berens MD: Should not be considered a primary screening modality of the skin.
• 19:41
  Rebecca Berens MD: Does not visualize smaller brain vessels.
• 19:43
  Rebecca Berens MD: So you can have, a small aneurysm or narrowing of a blood vessel that may not be seen well on this imaging.
• 19:49
  Rebecca Berens MD: So point being like this is a sort of.
• 19:53
  Rebecca Berens MD: Rough view.
• 19:54
  Rebecca Berens MD: That may pick up some things, but the more detailed stuff and as you'll hear so breast cancer, cervical cancer, colon cancer, some of the biggest cancers that are most common and kill people not detected by this test.
• 20:08
  Sonia Singh MD: Those
• 20:09
  Rebecca Berens MD: are all
• 20:09
  the
• 20:09
  Sonia Singh MD: tough
• 20:09
  Rebecca Berens MD: ones, basically.
• 20:10
  Rebecca Berens MD: And and some small, early things may not be caught either
• 20:14
  Sonia Singh MD: and then they're telling you that this is not equivalent to having a breast MRI with contrast.
• 20:18
  Sonia Singh MD: Which is what high risk women often will be getting, and then it's not equivalent to getting a low dose ct, which is what high risk people for lung cancer would be getting.
• 20:25
  Rebecca Berens MD: Yeah.
• 20:26
  Sonia Singh MD: And it's interesting just their wording too.
• 20:27
  Sonia Singh MD: It's not, it says can serve as an adjunct too, like they're really hedging here.
• 20:33
  Sonia Singh MD: They're like, do all your normal stuff, but then also come and get this thing maybe.
• 20:38
  Rebecca Berens MD: Yeah, and I think it's important when we're talking about these disclaimers, like why is this so when you get a full body MRI when I was looking on the company website, you would be in the scanner from anywhere for 40, from 45 to 60 minutes for a head to toe study.
• 20:52
  Rebecca Berens MD: When you get a normal targeted MRI of a specific organ Yeah.
• 20:56
  Rebecca Berens MD: You're in the scanner for 45 to 60 minutes.
• 20:59
  Rebecca Berens MD: Yeah.
• 21:00
  Rebecca Berens MD: So you're getting a much higher resolution and better image of that organ than you are when you're roughly going down through the whole thing.
• 21:09
  Rebecca Berens MD: And I'm not a radiologist, I do not claim to know all the nuances of radiology technology and reading but as I understand it, it matters a lot.
• 21:20
  Rebecca Berens MD: What kind of study, what strength of magnet, whether or not you use contrast, what area you're focusing on, that is all very important to the quality of your image and the diagnostic usefulness of that image for a radiologist versus if you're getting a quick scan head to toe in the same amount of time, it's just not gonna be the same resolution or quality.
• 21:44
  Rebecca Berens MD: Exactly.
• 21:45
  Sonia Singh MD: Does the whole body MRI include contrast?
• 21:47
  Sonia Singh MD: Do they give contrast?
• 21:48
  Rebecca Berens MD: So I actually couldn't tell directly from, but I think no, from what I could see, it did not appear to
• 21:54
  Sonia Singh MD: interesting.
• 21:55
  Sonia Singh MD: I had one patient try to get one of these and the company contacted me asking for additional medical information and I was wondering if that was in part.
• 22:05
  Sonia Singh MD: To customize the scan in some way, but I don't know the answer of whether they actually did that or not.
• 22:11
  Rebecca Berens MD: Yeah, so what I saw was that they do collect some health information upfront for the purpose of giving that information to the radiologist.
• 22:18
  Rebecca Berens MD: Radiologists always love that clinical correlation.
• 22:20
  Rebecca Berens MD: That's the joke in the medical world if you're not a medical person.
• 22:24
  Rebecca Berens MD: But for the radiologist, I think they would maybe if there were symptoms or history, maybe look more closely at a given area of the body if there was some reason historically that might be of more concern.
• 22:35
  Rebecca Berens MD: But as far as I could tell, it did not appear that contrast was given, which again, in some conditions makes a big difference.
• 22:41
  Sonia Singh MD: Right.
• 22:41
  Rebecca Berens MD: If you don't have contrast.
• 22:42
  Rebecca Berens MD: All that to say, the company itself does not claim that they actually can do everything that I think is.
• 22:48
  Rebecca Berens MD: Loosely sold.
• 22:49
  Rebecca Berens MD: And and there's quality concerns with the image in terms of usefulness for certain certain types of diagnoses.
• 22:56
  Sonia Singh MD: Yeah.
• 22:56
  Rebecca Berens MD: So then I wanted to talk a little bit about what you've alluded to earlier, how do we determine if a medical test is worth doing?
• 23:04
  Rebecca Berens MD: How do we determine the benefit of a medical test?
• 23:06
  Rebecca Berens MD: And so there's a few things that go into this.
• 23:08
  Rebecca Berens MD: So one is what is the accuracy of that test?
• 23:10
  Rebecca Berens MD: How sure can we be that the results of this test are accurate?
• 23:14
  Rebecca Berens MD: And that goes into things like sensitivity, specificity, positive predictive value, negative predictive value.
• 23:20
  Rebecca Berens MD: So if you're not medical, these terms may not mean a whole lot to you, but basically what it means is sensitivity is how likely is it to pick up.
• 23:26
  Rebecca Berens MD: A condition if you do this test.
• 23:28
  Rebecca Berens MD: And then how specific is it for that condition versus something else?
• 23:32
  Rebecca Berens MD: Yeah, so that sensitivity and specificity, positive predictive value is if this test is positive, how likely is it that you actually have that thing?
• 23:39
  Rebecca Berens MD: And if it's negative, how likely is it that you don't have that thing?
• 23:41
  Rebecca Berens MD: And I think there, to a lay person, there's this idea that a test is either positive or negative, and that's it.
• 23:48
  Rebecca Berens MD: Like it just is, right?
• 23:48
  Rebecca Berens MD: But there is no test that is perfect.
• 23:50
  Rebecca Berens MD: Every test has false positive, false negative.
• 23:53
  Rebecca Berens MD: Every test can miss things.
• 23:55
  Rebecca Berens MD: Every test can have a positive that didn't turn out to actually be true.
• 23:58
  Rebecca Berens MD: And it's just the rates of those various sort of errors that matter when we're, and in the context of the clinical situation.
• 24:05
  Rebecca Berens MD: So if you do a strep test on 10 people, none of whom are having a sore throat, some of'em might pop top, pop up positive, but is that a clinically relevant strep infection?
• 24:15
  Rebecca Berens MD: Or are they a carrier of strep?
• 24:17
  Rebecca Berens MD: There's a lot of of nuance that goes into deciding to use a test when it comes to accuracy.
• 24:22
  Sonia Singh MD: I think the approach a lot of people have is just isn't more information always better?
• 24:26
  Sonia Singh MD: Like even if The test is not perfect, even though it doesn't pick up everything, even though it might not be able to distinguish one thing from another.
• 24:33
  Sonia Singh MD: Isn't it better to just have the info than to not have the info?
• 24:36
  Sonia Singh MD: And I, we'll probably get into that.
• 24:39
  Sonia Singh MD: Yeah.
• 24:39
  Sonia Singh MD: That's when we talk about the harms.
• 24:41
  Sonia Singh MD: But I'm just acknowledging that is one reaction that I think a lot of people would have to you talking about the sensitivity's not great and the specificity may not be great, but don't we just, isn't it better to have the info than not have the
• 24:53
  Rebecca Berens MD: info?
• 24:53
  Rebecca Berens MD: Yeah.
• 24:53
  Rebecca Berens MD: So is it, so that's the next dimension of test is clinical benefit, like
• 24:57
  Sonia Singh MD: Yeah.
• 24:57
  Rebecca Berens MD: Is the, is this information useful?
• 25:00
  Rebecca Berens MD: And so how do we determine if something is useful?
• 25:02
  Rebecca Berens MD: It's useful if it would change our management of a condition.
• 25:06
  Rebecca Berens MD: And if that change in management would affect the outcome of treating that condition and especially is there benefit over another test that it already exists?
• 25:15
  Rebecca Berens MD: So if we're looking at a new test, which like, okay, we're gonna add, say you're gonna add whole body MRI to your annual screening regimen.
• 25:23
  Rebecca Berens MD: What is the benefit of adding that compared to the other tests that you already do,
• 25:27
  Sonia Singh MD: do,
• 25:27
  Rebecca Berens MD: And maybe cheaper.
• 25:28
  Rebecca Berens MD: And so that there's a lot of weighing that you have to do there of what is the benefit of this test?
• 25:33
  Rebecca Berens MD: What does it add?
• 25:34
  Rebecca Berens MD: And then I think the last aspect is like value both to the patient and to the system.
• 25:38
  Rebecca Berens MD: And this goes beyond just the clinical benefit of it makes your, you, if you, if we kind find a cancer that is treated, it makes you live another month or it makes you live another five years, right?
• 25:50
  Rebecca Berens MD: Like those are different, those are different outcomes.
• 25:52
  Rebecca Berens MD: And if you spent that last month that you had on chemo and in the hospital all the time versus you spent it at home and then found out a week before you died that you had it, which one was better for your quality of life?
• 26:05
  Rebecca Berens MD: There's a lot, there's a lot into that I think it's so hard to explain and to talk about.
• 26:10
  Rebecca Berens MD: 'cause like you said, it always sounds like more information is better, but.
• 26:14
  Rebecca Berens MD: When we look at the outcomes and the benefit to the patient, it's always a weighing it's not just, okay, you lived two weeks longer, you lived two months longer.
• 26:22
  Rebecca Berens MD: It's what was the quality of those last two months?
• 26:25
  Sonia Singh MD: See, I think people's response to that would be like that's not up to you to decide.
• 26:29
  Sonia Singh MD: And it's
• 26:29
  Rebecca Berens MD: not
• 26:30
  Sonia Singh MD: like that's up to me and I maybe I just want the two weeks longer no matter what it's like, or I wanna feel like I did everything I could to live two weeks longer for my family.
• 26:39
  Sonia Singh MD: So I, again, I think there's this distrust and this feeling that the doctor is making a decision for you about what you value and what you might want, and that this is a way to bypass all of that and just to get the information yourself, yeah.
• 26:51
  Sonia Singh MD: I think that's what people would say.
• 26:54
  Sonia Singh MD: But anyway, we'll talk about.
• 26:57
  Sonia Singh MD: We will talk about even if you go that route, what would be the potential, risks and benefits.
• 27:01
  Rebecca Berens MD: Yeah.
• 27:02
  Rebecca Berens MD: Yeah.
• 27:02
  Rebecca Berens MD: And I think then the last thing we're talking about, the value to both the patient and the system for the test is what is the experience of having the test?
• 27:09
  Rebecca Berens MD: And how much does it cost you?
• 27:10
  Rebecca Berens MD: Because these tests, these whole body MRIs are in the multiple thousands.
• 27:14
  Sonia Singh MD: Yeah.
• 27:14
  Rebecca Berens MD: And I think the idea is that you do it every year, because obviously you get one, one year, that doesn't mean that nothing would be there the next year.
• 27:22
  Rebecca Berens MD: So I think the idea is that this is a recurrent screening thing that you add to your regimen.
• 27:28
  Rebecca Berens MD: And so that becomes quite costly and I think, to your point, it is always up to the patient if they wanna pursue it or not, but I think it's just a conversation that needs to be had and really understanding the nuance of that before.
• 27:43
  Rebecca Berens MD: Just oh yeah, this can find all these things.
• 27:44
  Rebecca Berens MD: Sign me up.
• 27:45
  Rebecca Berens MD: Sounds good.
• 27:45
  Rebecca Berens MD: It's let's make sure we're understanding the nuance.
• 27:47
  Rebecca Berens MD: So we'll get into all of that when we get into the risks and harms too.
• 27:50
  Rebecca Berens MD: But I did wanna share a couple of studies that I found that were had examined the sensitivity specificity, positive predict, predictive value, negative predictive value, all those accuracy based things that I mentioned regarding a test.
• 28:03
  Rebecca Berens MD: So this first one here is whole body MRI for preventive health screening.
• 28:06
  Rebecca Berens MD: A systematic review of the literature.
• 28:08
  Rebecca Berens MD: It's from 2019.
• 28:09
  Rebecca Berens MD: And so this was a study that looked at multiple other studies reporting full body MRI findings in asymptomatic adults.
• 28:16
  Rebecca Berens MD: So this is in the population that we are talking about without a known disease syndrome or a genetic mutation.
• 28:23
  Rebecca Berens MD: So people that might, be getting this, who don't have a clinical reason why it would be ordered normally.
• 28:29
  Rebecca Berens MD: So there's 12 studies over 5,000 subjects.
• 28:32
  Rebecca Berens MD: And so the pooled prevalence, excuse me, of critical and indeterminate incidental findings was 32%.
• 28:41
  Rebecca Berens MD: So quite a high percentage of something being found.
• 28:44
  Rebecca Berens MD: Now, the difference how they defined critical versus indeterminate critical was like, meaning that it did require medical intervention that would change an outcome, whether mortality or morbidity, it would actually improve something for the patient to, to intervene versus indeterminate was it was a finding and it wasn't clear how much there was gonna be any effect of intervention or treatment for that finding.
• 29:07
  Sonia Singh MD: Those things don't seem like they should be clumped together.
• 29:10
  Rebecca Berens MD: Same so they do separate it out later, but Oh,
• 29:13
  Sonia Singh MD: okay.
• 29:13
  Sonia Singh MD: Okay.
• 29:13
  Rebecca Berens MD: But the point being like 32% something was found clump.
• 29:17
  Sonia Singh MD: Okay.
• 29:17
  Sonia Singh MD: But honestly, I'm surprised that in, what is it?
• 29:22
  Sonia Singh MD: 60 8% of people, nothing was found.
• 29:26
  Sonia Singh MD: That's honestly shocking because I would, I feel like the vast majority of people, you're gonna see a little degenerative disease, you're gonna see a little Yeah.
• 29:33
  Sonia Singh MD: A little, some little cystic stuff here and there.
• 29:35
  Sonia Singh MD: Like I I'm impressed that there's so many people that are totally normal.
• 29:38
  Rebecca Berens MD: So I don't think, I think I don't think this is including things like a little bit of fatty liver or a little bit of this is just a finding that was like what should we do about this?
• 29:47
  Rebecca Berens MD: Finding?
• 29:48
  Rebecca Berens MD: Not to say that there was definite benefit to having found this thing, but like it was indeterminate versus some of these things that are
• 29:55
  Sonia Singh MD: term.
• 29:55
  Sonia Singh MD: All of those things seem like they could you could argue that any of those.
• 29:59
  Sonia Singh MD: Things that to me feel very incidental, are things that, okay, now you've identified potentially that could be clinically stupid.
• 30:05
  Sonia Singh MD: Yeah.
• 30:05
  Sonia Singh MD: You could try.
• 30:05
  Sonia Singh MD: I don't know.
• 30:05
  Sonia Singh MD: Anyway okay.
• 30:06
  Sonia Singh MD: Yeah.
• 30:06
  Sonia Singh MD: So 32% had some finding.
• 30:09
  Rebecca Berens MD: Yeah.
• 30:09
  Sonia Singh MD: Which to me I'm just like, ooh, ding ding.
• 30:11
  Sonia Singh MD: Lots of patients probably doing this scan feeling like, thank God I did this thing.
• 30:15
  Sonia Singh MD: Yes.
• 30:15
  Sonia Singh MD: Because look at these things Yes.
• 30:17
  Sonia Singh MD: That they found.
• 30:18
  Sonia Singh MD: Okay.
• 30:18
  Rebecca Berens MD: And if you found an indeterminate thing, who can say if it made a difference To know that because now you know, you can't ever not know.
• 30:27
  Rebecca Berens MD: So that's a separate discussion.
• 30:29
  Rebecca Berens MD: Okay.
• 30:29
  Rebecca Berens MD: The there was substantial between study heterogeneity, meaning like a lot of variation between studies, which is not surprising.
• 30:37
  Rebecca Berens MD: Pulled prevalence of critical and indeterminate incidental findings together was significantly higher in studies that included cardiovascular and colon MRI versus studies that did not.
• 30:44
  Rebecca Berens MD: So obviously the more things you're looking at, the more likely you are to find something.
• 30:48
  Rebecca Berens MD: So pooled proportion of reported verified critical and indeterminate incidental findings was 12.6%.
• 30:56
  Rebecca Berens MD: So 32% something was found.
• 30:59
  Rebecca Berens MD: But verified findings, as in we did the follow up and we verified that was 12%.
• 31:04
  Rebecca Berens MD: So that's a lot of people.
• 31:06
  Sonia Singh MD: That's already a big jump.
• 31:07
  Sonia Singh MD: So like roughly half of those people who had something found initially when there was further investigation, that was actually not even a thing.
• 31:15
  Rebecca Berens MD: Yeah.
• 31:16
  Sonia Singh MD: Okay.
• 31:17
  Rebecca Berens MD: Yeah.
• 31:17
  Sonia Singh MD: Alright.
• 31:18
  Rebecca Berens MD: Six studies reported, so specifically reported false PO positive, false positive findings yielding a pooled proportion of 16%.
• 31:26
  Rebecca Berens MD: So these are things that again, going back to what Isha said about half of those people actually didn't have the finding when they went back to verify.
• 31:33
  Rebecca Berens MD: But these are people who all then went and got other testing, additional
• 31:36
  Sonia Singh MD: testing to,
• 31:37
  Rebecca Berens MD: so they had this vis this initial thing, oh, this thing's found.
• 31:40
  Rebecca Berens MD: Now you gotta go do some more testing, more cost, potentially harms associated with that.
• 31:45
  Rebecca Berens MD: Verification, whatever that was.
• 31:46
  Rebecca Berens MD: Was it a biopsy?
• 31:47
  Rebecca Berens MD: Was it, who knows?
• 31:48
  Rebecca Berens MD: Yes.
• 31:48
  Rebecca Berens MD: Was it a study with contrast?
• 31:50
  Rebecca Berens MD: So now you've been exposed to contrast that you weren't exposed to before.
• 31:52
  Rebecca Berens MD: Lots of potential harms that could have happened just in the verification process.
• 31:56
  Rebecca Berens MD: None of the included studies reported long-term verification of negative findings.
• 32:01
  Rebecca Berens MD: So that was interesting to me too.
• 32:02
  Rebecca Berens MD: So you didn't find anything.
• 32:04
  Rebecca Berens MD: But did we follow up to see if anything had popped up in the next five years that maybe could have been found?
• 32:10
  Rebecca Berens MD: We didn't have that data.
• 32:11
  Rebecca Berens MD: Only one of the studies reported false negative findings and that was a proportion of 2%.
• 32:16
  Rebecca Berens MD: So this is people who the study said there was nothing wrong, but there actually was something wrong.
• 32:21
  Rebecca Berens MD: So that's false reassurance, right?
• 32:22
  Rebecca Berens MD: You got a study, you got this test done and said oh, you're good.
• 32:24
  Rebecca Berens MD: There's nothing here.
• 32:25
  Rebecca Berens MD: But that was actually false reassurance'cause there actually was something there and that wasn't even reported by all of the studies.
• 32:30
  Sonia Singh MD: And I'm assuming that they're talking about things that could have been potentially seen on imaging.
• 32:35
  Sonia Singh MD: Correct.
• 32:35
  Sonia Singh MD: But were not seen on imaging.
• 32:36
  Sonia Singh MD: Correct.
• 32:36
  Sonia Singh MD: As opposed to.
• 32:38
  Sonia Singh MD: High blood pressure or something like
• 32:39
  Rebecca Berens MD: that.
• 32:39
  Rebecca Berens MD: Yeah.
• 32:39
  Rebecca Berens MD: Yeah.
• 32:40
  Rebecca Berens MD: Of course.
• 32:40
  Rebecca Berens MD: Okay.
• 32:40
  Rebecca Berens MD: Because yeah, these are things that would've been,
• 32:42
  Sonia Singh MD: yeah.
• 32:42
  Rebecca Berens MD: Potentially seen.
• 32:44
  Rebecca Berens MD: So yeah, so I thought this kind of reflected while what we've just talked about is you can have false positives, you can have false negatives, you can have findings that didn't change your life in any way, but now you've spent more time and money and brain space on them.
• 32:59
  Rebecca Berens MD: So how useful was this exercise to you?
• 33:04
  Rebecca Berens MD: And as you said, that is up, ultimately up to the patient to decide, but I think it's important to understand the limitations and these are some of the limitations.
• 33:13
  Sonia Singh MD: Yeah, I'm actually not philosophically totally opposed to the idea that patients can make these value-based decisions about what additional care they want to get in the healthcare space.
• 33:26
  Sonia Singh MD: I think that's an inev, that is a thing like in, within.
• 33:29
  Sonia Singh MD: The healthcare system, like traditional healthcare, we do have a certain finite number of resources and we have payment systems that require us to be, to follow certain guidelines so that it keeps everybody honest ish, although it really doesn't do a good job of that.
• 33:44
  Sonia Singh MD: We, a lot of these insurance denials, the, as much as you and I hate them, it's like they're there to actually protect the patient from getting a bunch of unnecessary, like a doctor from ordering a bunch of unnecessary things for somebody that they don't need and that are not gonna
• 33:57
  Rebecca Berens MD: It's to prevent the insurance coming from paying for a bunch of things.
• 34:00
  Sonia Singh MD: Okay.
• 34:01
  Sonia Singh MD: Yes.
• 34:02
  Sonia Singh MD: And ultimately it's to prevent them from paying anybody any money.
• 34:05
  Sonia Singh MD: Yes.
• 34:05
  Sonia Singh MD: Just deny you care so that the patient doesn't ever get what they should be getting.
• 34:09
  Sonia Singh MD: But anyway yes.
• 34:10
  Sonia Singh MD: The guidelines are there for a reason, but if.
• 34:14
  Sonia Singh MD: If you're in a situation where you have unlimited resources and your values are different, and you are in consultation with a qualified healthcare professional, making a decision to get this test and then to review the results with them, and you are already under the care of that physician and you are doing all of the evidence-based recommended screenings already okay, I guess we can say in my mind I'm like, all right, this person is going in fully informed.
• 34:41
  Sonia Singh MD: Maybe this gives them additional peace of mind and that's worth the cost of it to them.
• 34:45
  Rebecca Berens MD: Yeah.
• 34:46
  Sonia Singh MD: The concern I have is just that I don't think these companies have any interest in giving people true informed consent.
• 34:52
  Sonia Singh MD: Yeah.
• 34:54
  Sonia Singh MD: Ultimately they're just, they're profit driven companies that have good marketing.
• 34:58
  Sonia Singh MD: And the good marketing is not gonna be like, and by the way, make sure you're also getting your mammogram.
• 35:04
  Sonia Singh MD: And make sure you also talk to your physician about whether you qualify for high risk lung cancer screening.
• 35:09
  Sonia Singh MD: And also be aware that.
• 35:11
  Sonia Singh MD: About 50% of the findings on this may actually be not true on upon further testing information.
• 35:18
  Sonia Singh MD: It's just, they're never gonna have that con, maybe there's something written in the contract that you sign when you sign up for these, beyond that fine print that you read.
• 35:26
  Sonia Singh MD: But I just don't know that people have that full understanding when they go into it.
• 35:31
  Sonia Singh MD: And I don't think, and this is the thing that, you and I see on the other side of this all the time, I think they don't have a lot of appreciation for an understanding for how it can spiral out of control very quickly.
• 35:42
  Sonia Singh MD: And how yes, the MRI doesn't have radiation.
• 35:45
  Sonia Singh MD: And yes, maybe they won't give you contrast, but then maybe they find something and then you are gonna do a CT with contrast and then, oh no, now we're not really sure what that thing is, so we're gonna check it every six months.
• 35:54
  Sonia Singh MD: And even though statistically the likelihood of that thing being anything significant or worrisome is really low.
• 36:01
  Sonia Singh MD: Now that you've seen it, there's like a cover your behind yeah.
• 36:06
  Sonia Singh MD: Component to medicine where then it's we saw this thing, if we ignore it and it becomes something bigger, it's on us.
• 36:11
  Sonia Singh MD: So like we're gonna keep re-imaging it every six months or every year or whatever until, so actually, you know what happened with my mom is like relevant here.
• 36:19
  Sonia Singh MD: So she went for her total body CT in India on as u per usual.
• 36:24
  Sonia Singh MD: And my mom has pain in all kinds of different places and, constantly worries that she has a lot of different conditions, but she did not have pain in her chest wall.
• 36:33
  Sonia Singh MD: And they saw a little lipoma in her chest wall.
• 36:37
  Sonia Singh MD: And she had never complained about it before.
• 36:38
  Sonia Singh MD: That was not of all the areas that bother her.
• 36:41
  Sonia Singh MD: That was not one.
• 36:42
  Sonia Singh MD: But after they had noted it, she just became so fixated on But are they sure it's a lipoma?
• 36:48
  Sonia Singh MD: What if it's not a lipoma?
• 36:49
  Sonia Singh MD: What if it's solid?
• 36:50
  Sonia Singh MD: What if first she was like, I don't know, the radiologists were in a different country.
• 36:54
  Sonia Singh MD: Maybe they're trained differently.
• 36:55
  Sonia Singh MD: Maybe we should have it redone here and see if they still see it and if they agree that it's benign.
• 36:59
  Sonia Singh MD: And so then I think she came home and had another scan.
• 37:03
  Sonia Singh MD: And then after she had that scan, I think she ultimately had a biopsy.
• 37:07
  Sonia Singh MD: 'cause then she, I think maybe there was a little bit of disagreement on the two scans about what it was.
• 37:12
  Sonia Singh MD: And so then they were like we can put a needle in it if you're, uncomfortable.
• 37:15
  Sonia Singh MD: So then she got it.
• 37:17
  Sonia Singh MD: Biopsied.
• 37:17
  Sonia Singh MD: And then the, after the biopsy, she started having pain, which like maybe that was just scar tissue or something related to that intervention.
• 37:26
  Sonia Singh MD: And then ultimately, every time they tried to go in and do something else, she kept having more pain.
• 37:31
  Sonia Singh MD: So they were like, let's just stick size the thing.
• 37:33
  Sonia Singh MD: So then she had an excision, and then she had a complicate, she had a hematoma following the excision.
• 37:39
  Sonia Singh MD: So this is just a perfect example of how it seems like such a benign I'm just gonna get a scan, and it's okay, I'll I'll be cool about the results, and then.
• 37:49
  Sonia Singh MD: Like you said, once you see it, you can't unsee it.
• 37:52
  Sonia Singh MD: And it, it just spiraled into this whole other thing.
• 37:54
  Sonia Singh MD: And she still has a little bit of scar tissue in that area where she's just man, that thing never got better.
• 37:59
  Sonia Singh MD: And I'm like, you never should have got that whole body CT scan'cause we probably never would've seen this thing.
• 38:04
  Sonia Singh MD: But yeah, I just think for a lot of people it's hard to imagine that hypothetical of going down that route and ending up having to do all these things.
• 38:13
  Sonia Singh MD: And I think also people are so driven for by the desire to get the answer and find something that might be wrong, that they discount how much harm is done in the stress of that.
• 38:26
  Sonia Singh MD: Yeah.
• 38:26
  Sonia Singh MD: And every subsequent test that you do, every subsequent wait for the results, every next test, the time, the energy, the money, all of it.
• 38:33
  Sonia Singh MD: It's a, it's a big deal, you
• 38:35
  Rebecca Berens MD: know?
• 38:35
  Rebecca Berens MD: Yeah.
• 38:36
  Rebecca Berens MD: Especially, if you think, okay, how many hours did she spend.
• 38:41
  Rebecca Berens MD: Going to all of these various appointments.
• 38:42
  Rebecca Berens MD: And if you are someone who is a working parent and has older parents to take care of, and you're like, oh, I'm, let me I need to be healthy for all my people around me.
• 38:52
  Rebecca Berens MD: So I could see this exact scenario where you're like, there's so many people to depend on me.
• 38:55
  Rebecca Berens MD: I need to make sure I'm okay.
• 38:57
  Rebecca Berens MD: But now you've spent so many, so much of your time and energy and brain space following up on something that never was gonna affect your life.
• 39:03
  Rebecca Berens MD: It's actually harmed your very reason for getting to study.
• 39:07
  Sonia Singh MD: Yes.
• 39:08
  Sonia Singh MD: And the other thing I would think about is I feel like a lot of our follow-up guidelines for renal masses and pulmonary nodules and whatever, a lot of those were built probably on data of people who had the fun the thing found because they had some other scanning done.
• 39:23
  Sonia Singh MD: Yes.
• 39:23
  Sonia Singh MD: That was already a population that was sick or getting scans for something.
• 39:27
  Sonia Singh MD: So now I think if you apply all of those same, algorithms to people who just got these who were totally healthy and got these scans, just because, the pretest probability as we say in medicine, or the likelihood that there's actually something going on there for somebody who has no clinical symptoms and no, signs that they're ill in any way is low.
• 39:47
  Sonia Singh MD: So those might even just following the guidelines after you find something like that's incidental might not even be as helpful for you as we, we think it is,
• 39:56
  Rebecca Berens MD: yeah.
• 39:56
  Rebecca Berens MD: But as you said in our litigious practice environment, you are not gonna be the one to not follow the guidelines, right?
• 40:03
  Rebecca Berens MD: You're not gonna say oh yeah, that's probably fine.
• 40:05
  Rebecca Berens MD: Once you've seen it, you have to follow it all the way through.
• 40:07
  Rebecca Berens MD: And if those are the only guidelines we have, that's the guidelines you're gonna follow.
• 40:11
  Rebecca Berens MD: Even though they don't directly apply to that person, we have to be conservative.
• 40:14
  Rebecca Berens MD: We can't.
• 40:15
  Rebecca Berens MD: In the absence of evidence to the contrary, we have to just see it through.
• 40:19
  Sonia Singh MD: Yeah.
• 40:19
  Sonia Singh MD: Contrary to what I think a lot of the zeitgeist tells us doctors don't really wanna miss stuff.
• 40:24
  Rebecca Berens MD: No,
• 40:25
  Sonia Singh MD: we don't want to miss something that turns into something bigger.
• 40:27
  Sonia Singh MD: Yeah, especially once you've seen it, even if you think the risk is so low that it's something significant, you are stuck following it and it, it does suck.
• 40:35
  Sonia Singh MD: I'm just amazed like the last few episodes, sometimes when you've shared these studies where I'm just they're doing these on so many people.
• 40:41
  Sonia Singh MD: How hard would it be to do like a better quality longer term follow up?
• 40:44
  Sonia Singh MD: If they really wanna prove to us we catch, we, we improve mortality for patients with early stage pancreatic cancer we detect more ov show me that,
• 40:54
  Rebecca Berens MD: Yeah.
• 40:54
  Rebecca Berens MD: Yeah.
• 40:55
  Rebecca Berens MD: And that's the other thing is so there, there was a company sponsored study that I actually couldn't find the text for, but it was referenced.
• 41:02
  Rebecca Berens MD: On one of the company's websites.
• 41:04
  Rebecca Berens MD: And I couldn't find the text for it, so I didn't include it.
• 41:06
  Rebecca Berens MD: 'Cause I couldn't really read it.
• 41:08
  Rebecca Berens MD: But but even that, it was all about what they find not about the outcomes.
• 41:12
  Rebecca Berens MD: And I think that's the key.
• 41:13
  Rebecca Berens MD: Yes.
• 41:14
  Rebecca Berens MD: Difference is like when we are talking about a pap smear, getting a pap smear done is not fun.
• 41:21
  Rebecca Berens MD: No one likes going to get a pap smear, but we have really good data that saves lives from cervical cancer, like really good.
• 41:27
  Rebecca Berens MD: And getting this annoying regular.
• 41:31
  Rebecca Berens MD: Invasive test is worth it.
• 41:33
  Rebecca Berens MD: Because of the data we have on the outcomes differences.
• 41:36
  Rebecca Berens MD: But it, but that's not true of a transvaginal ultrasound of an, of for ovarian cancer.
• 41:40
  Rebecca Berens MD: We don't have that data.
• 41:41
  Sonia Singh MD: Exactly.
• 41:42
  Rebecca Berens MD: And that's, I think, where the difference is.
• 41:43
  Rebecca Berens MD: And like that, and that's again, what I wanna see as well is it's not just did you find something, it's, did finding that thing make a positive influence in that person's life?
• 41:52
  Rebecca Berens MD: Or did it more often make people's lives worse?
• 41:54
  Rebecca Berens MD: 'cause now they have more medical appointments to go to.
• 41:57
  Rebecca Berens MD: So I think your story actually illustrated all of the risks that I was gonna discuss perfectly.
• 42:02
  Rebecca Berens MD: The workup for the insulinoma and the accompanying risks of that work workup.
• 42:06
  Rebecca Berens MD: Like you said, you end up with more scans, more radiation exposure, potentially a biopsy and complications of a biopsy.
• 42:12
  Rebecca Berens MD: You end up with just the cost and time of doing all those things.
• 42:15
  Rebecca Berens MD: There's also MRI specific risks.
• 42:17
  Rebecca Berens MD: So if you have certain implants, you can't go in an MR MRI if you have certain types of metal.
• 42:21
  Rebecca Berens MD: If you're claustrophobic, a large percentage of people.
• 42:23
  Rebecca Berens MD: I found the practical guide to MRI imaging MRI safety claustrophobia in three to 7% of patients.
• 42:30
  Rebecca Berens MD: A lot of patients who have to get an MRI done for a clinically appropriate reason, we actually have to give them some sort of pre-medication to be able to tolerate lying in this very small scanner for a long period of time.
• 42:40
  Rebecca Berens MD: So it's not a pleasant test either.
• 42:43
  Rebecca Berens MD: And then, if there're, you hear like those crazy stories of the some magnetic object that somehow makes its way into the MRI machine room and like flies across the room that could injure you.
• 42:52
  Rebecca Berens MD: It's rare, but it could happen, right?
• 42:54
  Rebecca Berens MD: It's a risky must consider.
• 42:55
  Rebecca Berens MD: And then I think the biggest one for me though was one of the key things that advertise is the peace of mind, but this does not fully reassure you of anything.
• 43:06
  Rebecca Berens MD: There are false negatives, there are conditions that cannot be evaluated with this study.
• 43:11
  Rebecca Berens MD: So how much reassurance are you actually getting for the potential cost and the potential risks?
• 43:16
  Rebecca Berens MD: And that's I think to me the biggest thing because if someone I can think of an example of some patients that I have who don't have insurance and insurance is very costly for them.
• 43:27
  Rebecca Berens MD: They may be self-employed or they have, a really they had marketplace, but it was too expensive.
• 43:32
  Rebecca Berens MD: Whatever it was, they've dropped insurance.
• 43:33
  Rebecca Berens MD: And so now they're looking for how can I get the biggest bang for my medical buck?
• 43:37
  Sonia Singh MD: Yes.
• 43:37
  Sonia Singh MD: Yeah.
• 43:38
  Rebecca Berens MD: I could see that person saying, you know what?
• 43:40
  Rebecca Berens MD: I can't afford to do all this stuff.
• 43:42
  Rebecca Berens MD: I'm just gonna get this once a year.
• 43:44
  Rebecca Berens MD: And now they've missed all of the true evidence-based screenings.
• 43:48
  Sonia Singh MD: Yes.
• 43:48
  Rebecca Berens MD: And replaced it with this thing that is not a true replacement.
• 43:51
  Rebecca Berens MD: And they've spent a lot of money without getting a lot of value.
• 43:55
  Rebecca Berens MD: And that's, I think the other sort of issue that I see is if this is something you wanna do, in addition, you have all the resources in the world and you understand the risk be my guest,
• 44:04
  Sonia Singh MD: yeah.
• 44:04
  Rebecca Berens MD: We can.
• 44:05
  Rebecca Berens MD: Talk another time about the limited healthcare resources and how we should allocate them for our world.
• 44:10
  Rebecca Berens MD: That's a whole other discussion.
• 44:12
  Rebecca Berens MD: Yeah.
• 44:12
  Rebecca Berens MD: And that we can't get into here, but in our current setting, you can get whatever you wanna pay for, right?
• 44:18
  Rebecca Berens MD: And if that is what you wanna pay for, and you are fully aware of the risks and you have the autonomy to make that decision, as far as I'm concerned.
• 44:25
  Rebecca Berens MD: That's fine.
• 44:26
  Rebecca Berens MD: But to me it's just making sure that you truly do understand what it is that you're getting and what you're not getting.
• 44:32
  Rebecca Berens MD: And I don't think that is very clearly communicated in the advertisements, at least that I've seen.
• 44:37
  Rebecca Berens MD: And in the influencer's discussions of people who got their free scan,
• 44:41
  Sonia Singh MD: I'm so amazed that they put metabolic conditions and autoimmune conditions on there.
• 44:45
  Sonia Singh MD: 'cause those were Some of the things that immediately came to my mind of you could totally have uncontrolled hypertension, have nothing on these scans.
• 44:51
  Sonia Singh MD: You could have diabetes or pre-diabetes, have nothing on these scans.
• 44:54
  Sonia Singh MD: You can have thyroid disease and hyperthyroidism, nothing on these scans You can have.
• 44:59
  Sonia Singh MD: Multiple types of autoimmune disease that I can think of and have nothing on a scan.
• 45:04
  Rebecca Berens MD: Yeah.
• 45:04
  Sonia Singh MD: So I, this, and those are, over 50% of adults have high blood pressure.
• 45:08
  Sonia Singh MD: So these are some of the most common, high blood pressure and diabetes and prediabetes are some of the most common things we see in primary care.
• 45:14
  Sonia Singh MD: So if you are bypassing the normal doctor's appointment and doing this you're just, like you said, it's just a hugely false sense of security that you've done your due diligence.
• 45:24
  Sonia Singh MD: So I actually, I just, this ring a bell in my email when you were talking about that one study they always referenced.
• 45:29
  Sonia Singh MD: 'cause when my patient did one of these scans, the rep got very clingy with me and was trying to convince me to look, oh nice.
• 45:36
  Sonia Singh MD: These, and so he actually sent me, it's not, of course it is not the actual paper.
• 45:42
  Sonia Singh MD: It is it, to me it looks like a, it's like a poster.
• 45:45
  Sonia Singh MD: It's a brief it's got
• 45:46
  Rebecca Berens MD: oh yeah, that's, they had that on the website.
• 45:47
  Sonia Singh MD: They have.
• 45:48
  Sonia Singh MD: Oh, you saw that?
• 45:48
  Sonia Singh MD: Okay.
• 45:49
  Rebecca Berens MD: Yeah, I saw that.
• 45:49
  Sonia Singh MD: They did have they.
• 45:51
  Sonia Singh MD: They have some information here.
• 45:52
  Sonia Singh MD: So like the study was in 2,600 patients, like pretty good pretty good size.
• 45:58
  Sonia Singh MD: The mean follow-up was 14 months.
• 46:01
  Sonia Singh MD: Oh actually nevermind.
• 46:04
  Sonia Singh MD: The total number that were actually included in the study were only a thousand.
• 46:06
  Sonia Singh MD: 'cause they screened out some people who didn't wanna do the follow up and who didn't, who had active cancer at the time.
• 46:11
  Sonia Singh MD: Okay but this was healthy.
• 46:13
  Sonia Singh MD: This was like, as far as we know, healthy people.
• 46:14
  Sonia Singh MD: So the rate of cancer detection among those thousand was 2.1%.
• 46:20
  Sonia Singh MD: Positive biopsy rate is listed as 56%.
• 46:23
  Sonia Singh MD: I don't know if that means like the lesion that they saw was positive 56% of the time, but I don't know why they're calling it cancer if it was not positive.
• 46:30
  Sonia Singh MD: So I don't exactly know what that means.
• 46:32
  Sonia Singh MD: It's a 64% of the cancers were detected in an early stage.
• 46:35
  Sonia Singh MD: 36% were detected at late stage.
• 46:37
  Sonia Singh MD: Now let's look at what cancers they found, because that is really interesting data.
• 46:40
  Sonia Singh MD: The most common ones were prostate, which was three.
• 46:45
  Sonia Singh MD: Thyroid which was four, and breast, which was four, and then kidney was three.
• 46:51
  Sonia Singh MD: But even if you're just looking at prostate, thyroid, and breast, so first of all, breast cancer, you gotta wonder if some of these people had not had their recommended mammogram or breast MRI or all, like they had not had the evidence-based screen.
• 47:06
  Sonia Singh MD: Yeah.
• 47:07
  Sonia Singh MD: And who knows in how long.
• 47:08
  Sonia Singh MD: So those, and the fine print that you acknowledged, it says that it does not replace the, those screening tests and those are clearly superior for detection.
• 47:17
  Sonia Singh MD: Yeah.
• 47:17
  Sonia Singh MD: Breast cancers I.
• 47:19
  Sonia Singh MD: Thyroid cancers and prostate cancers.
• 47:22
  Sonia Singh MD: We know those grow really slow.
• 47:24
  Sonia Singh MD: Yeah.
• 47:24
  Sonia Singh MD: They're pregnant in a lot of people.
• 47:26
  Sonia Singh MD: I dunno the age ranges of this population.
• 47:29
  Sonia Singh MD: But if it was just an older population, those are, I don't know the prevalence rates off the top of my head, but if you just scan everybody's thyroid in prostate, you're gonna see a lot of those.
• 47:39
  Sonia Singh MD: You know the number 2.1%, it doesn't sound super impressive, but it's, it's a decent chunk of people.
• 47:44
  Sonia Singh MD: But then when you drill down and you look at, what were those cancers, a lot of those were probably cancers that were gonna be clinically insignificant for.
• 47:50
  Sonia Singh MD: They may never cause them any problems they made have died with those cancers present without ever having an issue from them.
• 47:56
  Sonia Singh MD: But
• 47:56
  Rebecca Berens MD: now they might have had a traumatic surgery in their neck or prostate, thyroid damaging surrounding nerves,
• 48:02
  Sonia Singh MD: thyroidectomy.
• 48:03
  Sonia Singh MD: Yeah.
• 48:03
  Sonia Singh MD: And they now they're incontinent and they've got all kinds of other quality of life issues.
• 48:07
  Sonia Singh MD: Yeah.
• 48:07
  Yeah.
• 48:08
  Sonia Singh MD: So
• 48:08
  Rebecca Berens MD: Those are the cancers that are most commonly the ones you die with, not of, and yeah, I think that's the other thing that like you said, there's this idea of more information is better, but especially in those two cases, it's often not, because there's often cases where this is something that may never have affected you, but now you've gone and gotten a bunch of intervention for it.
• 48:31
  Rebecca Berens MD: And like prostate and thyroid cancer treatment can be really devastating if there is a complication.
• 48:37
  Rebecca Berens MD: And even without major complications, there can still be functional issues.
• 48:40
  Rebecca Berens MD: You can have voice changes, you can have, like you said, incontinence, erectile dysfunction, a lot of issues that are quality of life problems from more aggressive treatment that was maybe necessary for those cancers.
• 48:49
  Sonia Singh MD: Yeah.
• 48:51
  Sonia Singh MD: So I think it just.
• 48:53
  Sonia Singh MD: I think when you just look at the headlines, of that study, it may look like, oh, okay.
• 48:56
  Sonia Singh MD: There's like something there.
• 48:57
  Sonia Singh MD: But I don't know, when you drill down to me and you don't know who these people were and how much were these people?
• 49:04
  Sonia Singh MD: It says they're asymptomatic, but are these people who were in contact with the healthcare system before or not?
• 49:09
  Sonia Singh MD: Yeah, if they were not, if you take a population of people who are like, I haven't seen a doctor in 10 years you're gonna find some stuff, yeah.
• 49:15
  Sonia Singh MD: Because they just have not been interacting with anyone who might be doing appropriate, screening and exams and things.
• 49:21
  Sonia Singh MD: So I don't know.
• 49:21
  Sonia Singh MD: I, again, this company, and I think there's probably a few of them now, but it's so big and it's so popular.
• 49:28
  Sonia Singh MD: I can't imagine that they don't have opportunity to give us more data to prove their point if it exists.
• 49:33
  Sonia Singh MD: And i'm just tempted to believe that they don't even wanna try to do the full study or to do a high quality study because they know that the findings are not gonna be like that.
• 49:43
  Rebecca Berens MD: Or they'll do it, but they'll do it after you've paid for it.
• 49:45
  Rebecca Berens MD: You're paying to participate in their study.
• 49:48
  Rebecca Berens MD: You, that's true.
• 49:49
  Rebecca Berens MD: You're paying thousands of dollars and they'll report your data later and it may not show what you were hoping it showed, but you paid for the privilege.
• 49:55
  Rebecca Berens MD: Versus if you're in a regular medical study, you get compensated for your time for doing the study.
• 50:00
  Rebecca Berens MD: So
• 50:00
  Sonia Singh MD: that's true.
• 50:00
  Sonia Singh MD: You're also paying to be their Guinea pig if they're,
• 50:02
  Rebecca Berens MD: you are.
• 50:03
  Rebecca Berens MD: You are.
• 50:03
  Rebecca Berens MD: And and that's the thing again, it's if you are fully informed and that's what you wanna do, and that's not using those resources for, that is not harming you in any way, by all means, but I think for most people.
• 50:15
  Rebecca Berens MD: That's probably not the case.
• 50:16
  Rebecca Berens MD: Most people, I feel like, are not fully informed.
• 50:18
  Rebecca Berens MD: There's not a full understanding of this because it's, the way it's presented is not exactly what is actually the case.
• 50:25
  Sonia Singh MD: Yeah.
• 50:26
  Sonia Singh MD: I have participated in clinical trials before and there is a very long, boring humdrum process where they talk you through all the terrible things that
• 50:32
  Rebecca Berens MD: could happen
• 50:32
  Sonia Singh MD: to you, including death.
• 50:34
  Sonia Singh MD: And I just can't imagine, I'll ask my patient who's done the scan, I'm like, cannot imagine them sitting you down and really having a thorough informed consent conversation.
• 50:43
  Rebecca Berens MD: Oh, I'm sure.
• 50:43
  Rebecca Berens MD: It's some sort of document you scroll through and like e-sign button when you book the appointment,
• 50:48
  Sonia Singh MD: you're right.
• 50:49
  Sonia Singh MD: Okay.
• 50:49
  Sonia Singh MD: All right.
• 50:49
  Sonia Singh MD: Let's go back to our where are we in our,
• 50:51
  Rebecca Berens MD: I think we're at, what can we learn from this as doctors and humans?
• 50:54
  Sonia Singh MD: Okay.
• 50:55
  Rebecca Berens MD: So what,
• 50:56
  Sonia Singh MD: what would you
• 50:56
  Rebecca Berens MD: say, what can we learn?
• 50:57
  Rebecca Berens MD: I think what we learn is people wanna be a proactive about their health.
• 51:03
  Rebecca Berens MD: Especially now there's a lot of health anxiety and we, and they strongly desire more information.
• 51:08
  Rebecca Berens MD: They wanna, it clearly explained.
• 51:10
  Rebecca Berens MD: And I think another thing that's, I saw the report that my patient got from their study and it was a beautiful, very long
• 51:16
  Sonia Singh MD: Yeah.
• 51:16
  Rebecca Berens MD: Very detailed report.
• 51:18
  Rebecca Berens MD: It gives a lot of information so it feels very complete, which is not what people get when they go for a regular screening.
• 51:24
  Rebecca Berens MD: Yes.
• 51:24
  Sonia Singh MD: Yes.
• 51:24
  Rebecca Berens MD: And it's written in very clear lay person language versus when you get your, mammogram result pop up on your portal and it's all bio blah, blah, and you're like, what does this mean?
• 51:33
  Sonia Singh MD: Rad too?
• 51:33
  Sonia Singh MD: What does that mean?
• 51:34
  Rebecca Berens MD: Yeah.
• 51:35
  Rebecca Berens MD: And I think there's this clear gap in the way that we're currently doing things that people want to be filled.
• 51:42
  Rebecca Berens MD: Like I want information and I want you to explain it to me and I wanna feel reassured.
• 51:46
  Rebecca Berens MD: Yeah.
• 51:47
  Rebecca Berens MD: And we're clearly failing at that.
• 51:49
  Rebecca Berens MD: Yeah.
• 51:49
  Rebecca Berens MD: 'cause people are turning to these other options.
• 51:52
  Rebecca Berens MD: And I think it, it comes down to our, innate fear of uncertainty.
• 51:55
  Rebecca Berens MD: And the sort of hidden threats that we wanna try to protect ourselves from that can make this sort of marketing very effective.
• 52:03
  Rebecca Berens MD: And I think, as doctors, our role really needs to be to make sure that we are giving people a full picture and helping them come to an informed decision.
• 52:12
  Rebecca Berens MD: Because again, I don't think either one of us at the end of this is you're an idiot if you do this.
• 52:15
  Rebecca Berens MD: You're not if you choose to do this and you understand the risk, I think that's perfectly reasonable.
• 52:20
  Rebecca Berens MD: But I think it's making sure that it's an informed decision is the most important thing for me.
• 52:25
  Rebecca Berens MD: So I think that's something that, that I'm taking away from it.
• 52:27
  Rebecca Berens MD: And I think now that I've done this deep dive, I feel it wasn't anything that I wasn't expecting.
• 52:32
  Rebecca Berens MD: I was like, I think this is what I'm gonna find and it is what I found, but I feel more prepared to talk about it.
• 52:37
  Rebecca Berens MD: With patients and give them actual data and and answer their questions about it.
• 52:43
  Sonia Singh MD: Yeah, I think my biggest takeaway from this is maybe when I talk to people about this, a lot of times they'll ask me would you have it?
• 52:49
  Sonia Singh MD: Would you get it?
• 52:50
  Sonia Singh MD: And I always tell them, I'm like, the fact that I, with my medical knowledge and I have the resources to go get it, but I'm not, that should say something to you.
• 52:58
  Rebecca Berens MD: Yeah.
• 52:58
  Sonia Singh MD: But I think a point that I would, I wanna make a better.
• 53:02
  Sonia Singh MD: Effort to bring home is just look, I respect your autonomy and like your values may be different than my values.
• 53:07
  Sonia Singh MD: Yeah.
• 53:07
  Sonia Singh MD: Your priorities may be different than my prior.
• 53:08
  Sonia Singh MD: Your resources may be different than my resources.
• 53:10
  Sonia Singh MD: And so this decision is up to you, but it's just my job, like you said, to make sure that you're fully aware of all of the risks and benefits and the limitations of this particular scan and how it fits in with all of the other things that we're doing for you in terms of your health.
• 53:25
  Sonia Singh MD: And I think just validating at the set the outset, like we did at the beginning of the episode, that it's so it's so natural to want, to do an additional screening or to do something else.
• 53:35
  Sonia Singh MD: And like the thought, I get scared by the thought of ovarian cancers and pancreatic cancer popping up in my patients, under my nose.
• 53:41
  Sonia Singh MD: That terrifies me, it, again, that doesn't mean we scan everybody head to toe or we just scan everyone's pancreas and ovaries.
• 53:48
  Sonia Singh MD: We have to be thoughtful and intentional about how we go about.
• 53:52
  Sonia Singh MD: Dealing with that.
• 53:54
  Sonia Singh MD: The other last point that you brought up that I'm like, we could just do such a better job of that in healthcare is to me it's almost become a red flag.
• 54:00
  Sonia Singh MD: How beautiful and color coded a results sheet is where like sometimes I'll get these microbiome reports and I'm like, this is beautiful, but doesn't,
• 54:09
  Rebecca Berens MD: me meaningless, but very crazy.
• 54:10
  Sonia Singh MD: Wouldn't say anything, looks very nice and looks, it looks very helpful.
• 54:13
  Sonia Singh MD: I don't know why we can't just do a better job of that in traditional medicine, like you said, even with a mammogram, would it kill us to have a paragraph that's just this is what this means.
• 54:23
  Sonia Singh MD: The percentage of women, put a few stats in there that give people a sense of okay.
• 54:28
  Sonia Singh MD: What benefit did I get out of this test?
• 54:30
  Sonia Singh MD: Or even just, and now with AI and so much auto, there's so many automation tools out there.
• 54:34
  Sonia Singh MD: I don't even think this would be that time consuming to create systems that
• 54:38
  Rebecca Berens MD: Yeah.
• 54:38
  Sonia Singh MD: Give lay language, and nice interpretation of results that translate like all of our medical jargon for people.
• 54:45
  Sonia Singh MD: That doesn't seem like it's that hard to
• 54:47
  do.
• 54:47
  Rebecca Berens MD: Yeah.
• 54:47
  Rebecca Berens MD: But we just, because the number of patients that have called me freaking out after they get an indeterminate mammogram.
• 54:54
  Rebecca Berens MD: And it's oh my gosh, I have breast cancer.
• 54:56
  Rebecca Berens MD: I'm like, no, this happens all the time.
• 54:57
  Sonia Singh MD: Yes.
• 54:58
  Rebecca Berens MD: Get the follow-up imaging.
• 54:59
  Rebecca Berens MD: We do not worry about it until we get the follow-up imaging.
• 55:02
  Rebecca Berens MD: This happens so frequently, and I'm like, if there was like a, like you said, the colors like green, orange, red.
• 55:08
  Sonia Singh MD: Yes.
• 55:09
  Rebecca Berens MD: Orange is don't freak out, but go get the other imaging green is you're good.
• 55:13
  Rebecca Berens MD: Come back next year.
• 55:14
  Sonia Singh MD: Yeah.
• 55:15
  Rebecca Berens MD: Red is okay, it's time to panic.
• 55:18
  Rebecca Berens MD: I think it there's so much queuing that we could do that would be more patient friendly and would make people feel more at ease and I understand what's happening.
• 55:27
  Rebecca Berens MD: Versus now it's this sounds really scary.
• 55:29
  Rebecca Berens MD: There's an asymmetry.
• 55:30
  Rebecca Berens MD: What does that mean?
• 55:31
  Sonia Singh MD: Yes.
• 55:31
  Rebecca Berens MD: It's yeah, we could definitely do a better job of that.
• 55:33
  Rebecca Berens MD: And I think yeah, I think that's something that, you and I probably in our setting when we're talking with patients about results, we are able to spend more time and getting into it.
• 55:42
  Rebecca Berens MD: And so I feel like we probably don't run into this as much, but in a big system where you're very busy and you have these auto sending of results in portals.
• 55:49
  Rebecca Berens MD: There should be a better way.
• 55:51
  Rebecca Berens MD: And like you said, maybe this is a good use of ai.
• 55:53
  Rebecca Berens MD: I've yet to be happy with ai, but this one could maybe be one.
• 55:56
  Rebecca Berens MD: That,
• 55:57
  Sonia Singh MD: that's for another episode.
• 55:58
  Rebecca Berens MD: Yes.
• 55:59
  Rebecca Berens MD: But yeah
• 56:00
  Sonia Singh MD: okay.
• 56:00
  Sonia Singh MD: Where can people go for more info?
• 56:02
  Rebecca Berens MD: So I'm, I put the US Presentative Preventative Services Task Force website here.
• 56:07
  Rebecca Berens MD: 'cause I think it actually does do a decent job of a, b, c recommendations of how much data there is behind different recommendations for screenings.
• 56:16
  Rebecca Berens MD: But I think the ultimate thing is this is an individualized discussion.
• 56:20
  Rebecca Berens MD: And like you said, you need to understand what your personal risk factors are.
• 56:22
  Rebecca Berens MD: So call your doctor, go for your physical and talk to'em about the screening stuff and figure out if there's things that you are due for that you, that are evidence-based that you should get.
• 56:33
  Rebecca Berens MD: And then if additional screenings are things that you're interested in.
• 56:37
  Rebecca Berens MD: Hopefully we answered a lot of questions about this one today, but you can have further discussion with your doctor about it.
• 56:43
  Sonia Singh MD: Yeah.
• 56:44
  Rebecca Berens MD: And make sure that they're not getting free scans from a full body MRI company if they recommend one to you, because that's a red flag.
• 56:52
  Sonia Singh MD: That's a good point.
• 56:53
  Sonia Singh MD: Yeah.
• 56:53
  Sonia Singh MD: When I looked in my email for that study the email, the title of the email was like, partnership opportunity.
• 56:59
  Sonia Singh MD: So partnership, I feel like doctors already get a lot of a bad rap for are they profiting from doing this colonoscopy or this, these tests or prescribing that pill, and I think you have to scrutinize these companies just as vigorously.
• 57:12
  Sonia Singh MD: Yeah.
• 57:12
  Sonia Singh MD: Because if you follow, I agree with following the money, but if you follow the money you're gonna find some.
• 57:17
  Rebecca Berens MD: Yeah.
• 57:18
  Rebecca Berens MD: And it, it is hard to be fully objective about something that you received for free.
• 57:24
  Rebecca Berens MD: Yeah.
• 57:25
  Rebecca Berens MD: Versus.
• 57:27
  Rebecca Berens MD: That was a gift to you from a company, right?
• 57:29
  Rebecca Berens MD: Versus if you're the person that went and pulled out your credit card and paid several thousand dollars, it's a very different experience.
• 57:35
  Sonia Singh MD: Yes.
• 57:36
  Sonia Singh MD: Yeah.
• 57:36
  Rebecca Berens MD: Yeah.
• 57:37
  Sonia Singh MD: The risk benefit equation has totally shifted, so
• 57:39
  Rebecca Berens MD: yeah.
• 57:39
  Rebecca Berens MD: Yeah.
• 57:40
  Rebecca Berens MD: Okay.
• 57:41
  Rebecca Berens MD: All right.
• 57:41
  Rebecca Berens MD: This was a great episode.
• 57:42
  Rebecca Berens MD: Thank you so much,
• 57:43
  Sonia Singh MD: Rebecca.
• 57:43
  Rebecca Berens MD: Yeah.
• 57:43
  Rebecca Berens MD: Thanks.
• 57:44
  Sonia Singh MD: Okay.
• 57:45
  Sonia Singh MD: Bye.
• 57:45
  Rebecca Berens MD: Bye.
• 57:45
  Rebecca Berens MD: Bye.
• 57:47
  Sonia Singh MD: Hey guys.
• 57:47
  Sonia Singh MD: Last but not least, we have a very important disclaimer.
• 57:51
  Sonia Singh MD: This podcast is intended for educational and entertainment purposes only.
• 57:55
  Sonia Singh MD: The content shared on this podcast, including but not limited to opinions, research discussions, case examples, and commentary, is not medical advice and should not be considered a substitute for professional medical evaluation, diagnosis, or treatment.
• 58:10
  Sonia Singh MD: Listening to this podcast does not establish a physician patient relationship between you and the hosts.
• 58:15
  Sonia Singh MD: We are doctors, but not your doctors.
• 58:17
  Sonia Singh MD: Any medical topics discussed are presented for general informational purposes and may not apply to your individual circumstances.
• 58:25
  Sonia Singh MD: Always seek the advice of your own qualified healthcare professional regarding any questions you have about your health, medical conditions, or treatment options.
• 58:32
  Sonia Singh MD: Never disregard or delay medical advice because of something you've heard on this podcast.
• 58:37
  Sonia Singh MD: While the hosts are licensed physicians, the views and opinions expressed are our own and do not represent those of our employers, institutions, organizations, or professional societies with which we are affiliated, although we do our best to stay up to date.
• 58:51
  Sonia Singh MD: Please note that this podcast includes discussion of emerging research, evolving medical concepts, and differing professional opinions.
• 58:58
  Sonia Singh MD: Medicine is not static and information may change over time.
• 59:01
  Sonia Singh MD: We, the hosts make no guarantees about the accuracy, completeness, or applicability of this content, and we disclaim any liability for actions taken or not taken based on the information provided in this podcast by listening to the Antisocial Doctors Podcast, you have agreed to these terms.
• 59:17
  Sonia Singh MD: Thanks again for joining us.