Your Checkup: What You Wish Your Doctor Explained

Full Body MRI: Marketing Hype vs. Medical Reality

• Ed Delesky, MD and Nicole Aruffo, RN • Season 2 • Episode 3

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• Full body MRIs cost around $2,500 and are being promoted as the "gold standard" for preventative health without proper medical context
• Unlike established screening tests, these scans haven't been evaluated by medical societies for appropriate use in healthy populations
• 15-30% of diagnostic images have at least one incidental finding, which can lead to unnecessary anxiety and further testing
• The marketing tactics use fear-based messaging about finding cancer early, which might be ethically concerning
• These services create healthcare disparities since they're only accessible to those with financial resources

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Production and Content: Edward Delesky, MD & Nicole Aruffo, RN
Artwork: Olivia Pawlowski

Ed Delesky:

Hi, welcome to your checkup. We are the patient education podcast, where we bring conversations from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I'm Ed Delesky, a family medicine resident in the Philadelphia area.

Nicole Aruffo:

And I'm Nicola Aruffo. I'm a nurse.

Ed Delesky:

And we are so excited you were able to join us here again today. So by the time you listen to this, we'll have had a few days in between recording and release day. But I'm wondering, after this, I'm going to get taco seasoning to have what for dinner?

Nicole Aruffo:

Well, we're having enchiladas for dinner. I mean, like white people enchiladas.

Ed Delesky:

Sure, but I always love. This is also one of my favorite meals. There's a rotisserie. Like in the next 24 to 48 hours, all I'll be able to do is talk about enchiladas, and it leaves me very excited. How are you feeling today?

Nicole Aruffo:

I'm feeling good today.

Ed Delesky:

Excellent. Are you excited to be sitting down and to get talking about you?

Nicole Aruffo:

know, do I sound excited, you?

Ed Delesky:

do you really sound like you're ready to?

Nicole Aruffo:

I'm actually trying to. You sprung this on me about seven minutes ago, so I couldn't think of anything for pre-show banter. Actually, we never talked about how we um we finished the pit.

Ed Delesky:

Oh, we certainly did. We talked on here about watching the Pit though. Is that correct? Yeah, yeah, incredibly accurate show. We really liked it a lot.

Nicole Aruffo:

I also really liked. I don't think we talked about that last scene Well, I don't know if it was the last scene but the scene with what are you doing? The scene with um Mel at the end and she, like, picks up her sister yeah and the sister's like, what are we doing?

Nicole Aruffo:

today?

Nicole Aruffo:

It's Friday and she's like let's get pizza and then we'll like watch a movie and whatever, and like I felt like that I don't think we've talked about this because I felt like that was such a good representation of like what it's like to go to work and like something like awful happens.

Nicole Aruffo:

Obviously people aren't doing like working during mass casualties all the time, but even if, like someone dies and then you like go home and the person you go home to isn't like a medical person, and then, or even if you're at work and like you have to just like put on a happy face, go next door and act like the kid next door isn't like actively dying or something crazy like that. But I thought that was a really good representation of like that when something crazy happens and then like you go home or whatever and you just have to like act like everything's fine, because even like as the viewer, like you're watching it, and then like you go home or whatever and you just have to like act like everything's fine, because even like as the viewer, like you're watching it and you like have all this anxiety of like what just happened and then she's just like chatting with her sister, like, yeah, let's, we're gonna like watch a movie, because it's Friday, and order pizza yeah don't you think?

Ed Delesky:

I do. I think it was a really like subtle. That's a really subtle scene that I don't I feel like you kind of have to live it to know it, and yet very powerful and for all of the reasons that you described there, um, we have a benefit with each other. We're like I don't know, even yesterday I came home and I was talking about that tough like experience I had and like we serve as a sounding board for each other if that ever comes up. But yeah, that was it. That was a really important scene. Maybe I don't know if it was underappreciated in, like the public eye, but you know, with whatever medium we have here, I'm glad you brought it up, because that was a. That's a good point. You didn't bring that up outside of this, yeah, but you have to compartmentalize and I guess like, or that's a coping mechanism for the things you see yeah, you push your feelings deep down and you never feel them that's one way to do it another might be compartmentalization or processing.

Ed Delesky:

Whatever you see and experience, I mean you've seen some, some of the craziest things that a person can see.

Nicole Aruffo:

So anyway, I thought it was good.

Ed Delesky:

That is good and in other TV viewing experience, we're going to watch the Valley tonight.

Nicole Aruffo:

Oh my God, I'm so excited. Jax is crazy.

Ed Delesky:

Yeah, I mean, they've always known this guy is crazy.

Nicole Aruffo:

And then to oh my God Wait. So this is going to be for a select audience. However, it's very important. So Kristen was on Watch what happens live last night and do you remember whatever early season of Vanderpump like this green dress that Kristen wore when her and Sandoval were broken up and then she went, went to his apartment to like pick up the cable box and she had on this like green, like going out dress. She was like all dolled up. It was like a whole scene Cause it was like I guess like Sandoval and Schwartz maybe like at his apartment and Kristen just like casually comes over to um pick up the cable box and they're like why is she all dressed up? Like why did she wear this? And then it became a thing online and it kind of became this like iconic thing in the.

Nicole Aruffo:

Bravo world of. Like Kristen's green dress Okay, and she was on watch what happens live last night and she, like, brought the green dress to. Andy and she was like retiring the green dress, and now it's in the clubhouse.

Ed Delesky:

Oh, no, kidding, it's so iconic, that's awesome. It's so iconic, that's awesome, that's so funny do you remember that scene?

Nicole Aruffo:

I will have to do a rewatch if not we do.

Ed Delesky:

I mean like somehow summer house is our comfort show um I maybe we just do yearly rewatches of all of these shows.

Ed Delesky:

I think we should maybe that's what's happening people say that's a sign of anxiety or you keep rewatching the same show over and over again because you know what's going to happen I'm seeing similar things, and it's like a a tool for emotional regulation, is what I saw, because there's a certain predictability to it that you know is comforting, or it's anxiety, who knows? We're both probably working on something with that at some level. Well, all right then. What do you think?

Nicole Aruffo:

Well, all right, then Should we get started, yeah, okay.

Ed Delesky:

So what are we going to talk about today, nick?

Nicole Aruffo:

Today we're talking about the full body MRI. What am I trying to say? I guess being like marketed more to the public. Pernuvo is like the big one that's in like a couple of the big cities. I think Ezra is another one, but yeah, we're going to talk about it because it's something that's offered as like a private pay. Do this full body MRI and, you know, find out everything you've ever wanted to know about your body.

Ed Delesky:

Exactly, and I think more so it's in the zeitgeist as a form of rapidly spreading social media news. So that's what you can expect out of this episode today Maybe not so much of a straightforward educational one, but maybe more our interpretation of a this is like a quasi pop culture thing that's happening.

Ed Delesky:

I would say Very topical, if you will. So I mean, you described it here like people are getting these full body MRIs and this is nothing short of like head to toe. You are going in an MRI which stands for magnetic resonance imaging. It tends to be like a really expensive imaging study but there's no radiation, which is a pro. But usually it's used for very specific purposes as a part of diagnostic workups.

Nicole Aruffo:

but it seems like now, when you were, when you propose that we do this episode, that there's more out there, there's more to these that's coming out yeah, I mean, I brought it up because I think that people should know I don't know, I guess, like the pros and cons of like all of it and like maybe, like what it could lead to, why it's not something that's usually recommended, and mainly because, like, a lot of influencers are doing brand partnerships with these companies specifically, and it's like okay, you're, you know, on a reality tv show or you do makeup on the internet and like those are all great things, but then they're going to get these full body MRIs because they were offered it for free or got paid to do it.

Nicole Aruffo:

And then they're out here kind of like talking as if this is the gold standard for, like preventative health and how everyone should do it and you should do it once a year, and like it can find x, y and z and like it's. I feel like they're talking as if it's better than it is and how I don't know, like what they're saying is just what's the? I feel like I'm there's a word it's like short-sighted, poorly, poorly contextualized.

Ed Delesky:

Yeah, and I completely agree with you.

Nicole Aruffo:

I think it's like they were offered something for free oh yeah they did it and now it's like oh, now, like I have this big influence because of you know, my social status, of whatever, and now I'm gonna tell all these people that they have to go spend twenty five hundred dollars to get this full body mri and like this is going to help them so much like medically, and kind of giving this like medical advice, that they really can't speak on.

Nicole Aruffo:

Exactly no, I, and I totally agree with you, because these one it's flawed, because they're being paid to basically advertise this imaging, which is mean it's the same thing as like the influencers who do brand partnerships, which like there's nothing wrong with that, like I wish I could get paid to do that, like I'm doing the wrong thing in life sure that like offer this um or they get paid to do a brand partnership with like a supplement, and they're like this is gonna fix x, y and z and like it's just like this statement has not been reviewed by the fda?

Ed Delesky:

yeah, yeah, and I think so. One of these content, one of the pieces of context here that's important, is that, like when it comes to screening because you said, like this is being like pitched as this, like paragon of preventative medicine and screening tests are highly scrutinized by panels and panels and panels of experts, and then various different societies disagree on proper screening, and so it's important to understand the definition of screening. Is that screening is looking for a disease in an otherwise normal healthy population, in an otherwise normal healthy population, like none of the people that you're looking for something. You expect to find something, but you're looking because you know that if you do look, you'll find enough where it's beneficial to do something about it as opposed to other things. So, like we're talking about colon cancer screening Like age 45 and up, everyone should be getting colon cancer screening or their cervical cancer screening.

Ed Delesky:

Like age 45 and up, everyone should be getting colon cancer screening or their cervical cancer screening. These things have been evaluated with very valuable, high-yield tests that should be done and have been evaluated. What hasn't been evaluated? The whole body MRI. So these are some things that I think about when this topic comes up.

Nicole Aruffo:

And also I think it's important to note that there is a difference between getting a whole body MRI and they typically advertise them that they, you know, like they only take an hour in and out real quick. There's a difference between doing that and then getting an MRI on just one body part, like that is more thorough, and then just doing right Because you could have an MRI on one part of your body that could take a half hour, it could take over an hour, and like that's more thorough than just doing like a once over eyeball.

Ed Delesky:

Look Absolutely right, that like of your whole body, that only over eyeball look Absolutely Right.

Nicole Aruffo:

That like of your whole body. That only takes one hour.

Ed Delesky:

Exactly, it's not all created the same. Like you get a brain MRI, there are different types of brain MRI where they look at stuff, but, like you said, like you just give it a once over up and down, it doesn't necessarily capture the whole picture. So we were talking about screening tests and how those have been highly scrutinized by important medical societies and that, like these, while they may find things, they may not be the most thorough, they can miss things, I suppose. But one thing I think that really needs to be stated out loud is that 15% to 30% of diagnostic images have at least one incidental finding. And the concept of the incidental finding, as I get deeper and deeper into practice, becomes more and more important, honestly.

Ed Delesky:

And they come up with the lung cancer screening, ct scans all the time, Because for people who have smoked for a certain age and for a certain duration, we will have a whole episode about this. There is yearly lung cancer screening and, wouldn't you know there are tons of things to find in the chest that may or may not have been important at one point in your life, and the incidental finding is just a very complicated thing that has a lot of downstream effects. And if now we're thinking about getting everyone a whole body MRI. There's going to be a lot of stuff that we see.

Nicole Aruffo:

There is a lot of stuff Cause I looking up um, I mean just now, but even like before this, because people on tiktok are posting, you know, screenshots of, like their results yeah from what they get which um.

Nicole Aruffo:

When I was like looking more into this, it seems like these are all also read by ai and not like an actual trained eye of a radiologist. There you go, it'll like list, you know every kind of like body system, and then it'll be like what? Like one minor finding, one minor finding nothing, normal, blah, blah, blah. But like a lot of them that I saw would be like it would say like one minor finding, and then they clicked on it and then it's like one small um. It's like in I forgot exactly what the wording was like one small, indeterminate lesion yeah, and like there you go.

Nicole Aruffo:

That can be really scary because it's like, okay, is that like a cyst or is this like changing my life now? But then then like you go to the doctor and you're like, oh, I got this MRI, I have aion, and now your doctor has to do something about it and like further work up that you at the end of the day, you know ideally everything would turn out fine, but like might not have needed, like what if you need a biopsy? And like that comes with another whole host of risks and blah, blah, blah, and it's just like yeah, Plus, like the anxiety of it on top of it is exactly the the time spent worrying about what?

Ed Delesky:

could this be when, in a this is like such like a fifth dimensional view of life where, like you go through life and like one act can change the arc of your entire life and like on one path, you went through your entire life? And like on one path, you went through your entire life and never knew that you had a four millimeter lesion in your lung and you never spent a moment of your day worrying about that. And there is another path where you had a CT scan of your chest or you had a whole body MRI and you know that there's a four millimeter lesion on your lung and you are left laying sleepless at night wondering.

Nicole Aruffo:

Yeah, it can really change the way, like a healthy person, like thinks about their health.

Ed Delesky:

Yeah, like you go from being a healthy person to now a patient with a lesion overnight in one moment, and I think the complicated thing here is that there will be things found. There will be important things found, like for sensationalization, which is why this has like come to the forefront so much. Like duane wade was like found to have a kidney cancer and it was early stage with the whole body mri, and like they found that and that happens yeah yeah, like, like people that's also not guaranteed to happen.

Nicole Aruffo:

Like this again, like once over whole body MRI is not guaranteed to find a cancer, even in the early stages, like before you have any symptoms, like you, that might still happen to you and it might not pick up on this whole body. Less thorough MRI.

Ed Delesky:

Exactly so. It's not as sensitive, maybe not as specific, and I can't sit here and say like for some random person out there who may stumble upon a whole body MRI and that for that individual it doesn't change their life.

Nicole Aruffo:

Yeah for better or for worse.

Ed Delesky:

Will be a lot of people where we find things where it didn't matter. And one thing people should recognize that often maybe isn't explained is that recommendations from societies like the colon cancer screening recommendation recommendation is for populations of people and they look at all of these people and they say the best group decision for all of these people is age 45 and up up to a certain upper limit should get colon cancer screening every so often from different methods. But then how do you explain the individual who has a family history of colon cancer and the person had colon cancer in their family discovered at the age of 45? Well then, yes, that person needs colon cancer screening at age 35.

Nicole Aruffo:

Yeah, but honestly I feel like all of those strong family history things that have a big factor in what you decide for someone, right?

Ed Delesky:

Sure, and I guess the overall arching point I'm trying to make is that recommendations from societies about these big sweeping things are about groups of people and not individuals. And so we're in a place, and I think in science and healthcare, where there are really motivated, interested, capable consumers of healthcare. And now, like you're able to purchase a whole body MRI here, probably outside of insurance, and like the way that health information has flowed, moves faster and technology moves faster, then scientific processes are able to keep up and make a risk assessment. So these are coming to market, they're flushing out fast and people are buying, buying, buying, they're scheduling, they're going and the experts haven't even picked a date to meet and say let's take a look at this and see like is this worth it or is it not?

Ed Delesky:

So it goes unstudied, question mark, unsure. When it lands across the desk of your doctor, it's like oops, I don't know what to do about this. It's a complicated thing and it's not just isolated to these, it's everywhere. It's a ton of things and information is traveling so quickly that it highlights the factor that a lot of this is a partnership in someone's health. The hierarchy of information has flattened, incredibly and maybe dangerously, because there's context to all of this. We're taking what may be a 40-minute podcast to dive into the complexities of all of this. Like we're taking a what may be a 40 minute podcast to dive into the complexities of all of this, but like people are scrolling and they see a sentence and like form opinions based on that.

Nicole Aruffo:

Yeah, I mean I could see the other side too of like why someone like would be interested in getting it just to kind of like you know, see what it says, yeah, and also like, so the typical like going price is $2,500, and like I could see someone. I mean like I went to schedule a brain MRI and they told me my copay was $2,500, so I could see someone being like oh, why would I do one body part when I can just do the whole thing for the same price?

Ed Delesky:

Totally, and that's part of the consumerism and the market driving prices down. So hopefully that would equilibrate over time. Yeah, it leaves me wondering. It leaves me wondering. I mean, I have the prices up here. They're stratified a little bit actually. So, yeah, it's comprehensive whole body scan. They say the scan time is 45 minutes and $2,499 for US dollars.

Ed Delesky:

They're claiming that it's a comprehensive imaging based health assessment that includes an evaluation of major organs and spine for cancer, aneurysms and disease, and it does not include arms or feet. This also includes an enhanced screening with a whole body scan. This scan time is 60 minutes. This is only completed in a couple cities and it's $4,000. To round up by a dollar and it says our most advanced multimodality screening includes our comprehensive whole body scan, lab testing for critical biomarkers and advanced brain health assessment and our FDA cleared body composition analysis. Don't even get me started about the like 500 biomarker labs of things that also won't be relevant, most likely in your life. Then there's a head and torso one 1800 bucks, 45 minutes. You can imagine what that's scanning and torso for a thousand dollars. A quick scan designed for those concerned about catching cancer early in the torso.

Nicole Aruffo:

Stop To identify early solid tumors. This is emotional, like marketing too that is awful that's awful they're like exploiting people to be like we're gonna catch cancer early when there's that's that's icky.

Ed Delesky:

Yeah, I don't like that. I don't like that.

Nicole Aruffo:

I don't like that at all.

Ed Delesky:

Right, Because they're exploiting people's emotions and fears of the unknown to push their product. And at the same time, in 10, 15 years from now, is the USPSTF going to say grade A recommendation 30 years old, whole body MRI. I don't know, Maybe.

Nicole Aruffo:

Probably not, I don't know. That's a lot of empty promises they have going on over there, I also think so.

Ed Delesky:

So, like with this technology being so new and having not been able to be reasonably assessed, like all of this is subject to conjecture and it's all about. It's an access issue as well, like we have another thing dividing the haves and have nots for someone to be able to detect something, perhaps.

Nicole Aruffo:

Yeah, I mean, you don't have to go to the doctor get a script, you don't have to have insurance.

Ed Delesky:

Or, like God forbid, you couldn't even afford this to be able to do this, let it like once let alone yearly.

Ed Delesky:

so then that creates an increased disparity, where then I could totally see studies coming out later saying, like people with a higher socioeconomic status and higher resources are maybe or maybe not experiencing benefit from this because they're able to access it and get early detection, or they have, like, problems because of overdiagnosis and yeah, like if you're a celebrity, even if you're, you know, like a C-list celebrity, and you get this and you find something.

Nicole Aruffo:

But you, you know, have connections with all the right people and the right doctors and whatever, and like you do x, y and z and maybe you, you know one incidental finding.

Ed Delesky:

Maybe that leads to something a specialist appointment that you waited, like three months for six months for yeah and then like another imaging study after that to maybe have a deep needle stuck in you somewhere.

Nicole Aruffo:

Yeah, I mean and also, yeah, like your average person doesn't really have. I mean, just think about, like, the number of people who don't even have a primary care doctor, yep. Like they get this information Maybe there is something that's found on it but like, or even just people who don't know how to like navigate the healthcare system in this wonderful country that we live in, right, like if they get this and what if they're? Like, oh, I don't know what to do with this.

Ed Delesky:

Right, oh, my aort is dilated a significant amount. Let me just hang out with that. Like, are they liable?

Nicole Aruffo:

That's what I don't like for discovering something. Yeah Cause it's not like, like, if you get imaging, those results are sent to the physician who ordered it. So, like what happens with like?

Ed Delesky:

you know what happens to these Like. Who's liable if like?

Nicole Aruffo:

I'm sure you sign something that like says they're not. It's like totally in the weeds and they're like we're not liable for any findings Like we're not liable for our computer reading this and giving you whatever answers it spits out.

Ed Delesky:

You decided to get this outside of. Like your relationship with the doctor blah, blah blah. It's just very complicated and, like you can tell, we're like we're back and forth Cause like yeah, there's a lot of issues with it, but like there's a lot of area for study to be had right. Like we can't tell if someone who actually does have access to this is this going to be better for them, is it going to be had right? Like we can't tell if someone who actually does have access to this is this going to be better for them, is it going to be worse for them? Individuals will vary population wise. I don't know yeah do you?

Ed Delesky:

I don't, I guess, I just wish. I guess I find it the key piece you said in the beginning.

Nicole Aruffo:

I find the like influencer, emotional marketing, personal experience type stuff frustrating yeah, and it's not even like it's just the fact that they're speaking again like this is the gold standard and like this is what everyone needs to be doing, and like they have no like background or anything they have, like don't have a leg to stand on for any kind of these medical recommendations that they're making. Right, that's like the frustrating part.

Ed Delesky:

Yeah, that might be top of the list. And the second thing on the list is this If you're concerned about cancer early in the torso, we'll look for solid tumors for you. Oh my God. Well, thank you for coming back to another episode of your Checkup. Hopefully you were able to learn something for yourself, a loved one or a neighbor.

Ed Delesky:

And please, if you found this interesting or you found any of our other episodes interesting, do two things. If you could send this to a loved one or a neighbor and go to the bottom of our show notes, where you found our episode, and go looking for our email list and you can sign up. You'll get email notifications that episodes came out, but you will also, as we expand our written materials available, be subject to newsletters. God bless you. Subject to newsletters. When we have blog posts on Substack, you'll be notified that way and you'll get the notification that new episodes came out. Hopefully you learned something today. God bless you. Thank you, but, most importantly, stay healthy, my friends, until next time. I'm Ed Delesky. I'm Nicole Arrufo. Thank you, goodbye, bye. This information may provide a brief overview of diagnosis. Stay healthy, my friends, until next time I'm ed dileski I'm nicole rufo thank you, goodbye, bye.

Ed Delesky:

This information may provide a brief overview of diagnosis, treatment and medications. It's not exhaustive and is a tool to help you understand potential options about your health. It doesn't cover all details about conditions, treatments or medications for a specific person. This is not medical advice or an attempt to substitute medical advice. You should contact a healthcare provider for personalized guidance based on your unique circumstances. We explicitly disclaim any liability relating to the information given or its use. This content doesn't endorse any treatments or medications for a specific patient. Always talk to your healthcare provider for complete information tailored to you. In short, I'm not your doctor, I am not your nurse, and make sure you go get your own checkup with your own personal doctor.

People on this episode

Contributor

Nicole Aruffo, RN

Host
Contributor

Dr. Edward Matthew Delesky, MD

Producer