Summary: 

Dr. Daniel Durand, a renowned physician and healthcare innovator, joins Wellness You Way to discuss his work at Prenuvo, a company pioneering whole-body health scans. Dr. Durand shares his diverse background, including his time at McKinsey & Company, where he gained valuable insights into healthcare implementation and change management. He also highlights his leadership roles at Evolent Health and Johns Hopkins, where he focused on value-based care and accountable care organizations. Dr. Durand emphasizes Prenuvo’s mission to revolutionize healthcare through its advanced whole-body scans, which provide comprehensive insights into an individual’s health. He discusses the potential of these scans to detect early signs of disease and empower individuals to take proactive steps towards better health.

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Full Episode:

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Transcription:

Megan Lyons: Now, I really thank you so much, Dr. Daniel Durand, for coming on Wellness you way. I’m very excited to have you here today.

Dr. Daniel Durand: It’s great to be here. Thank you so much for the invitation.

Megan Lyons: Of course. Well, I was really excited when your team reached out because I’m a big fan personally of the prenuvo scan. I did my own well before you and I were in contact earlier this year and have just been fascinated as I’ve learned more and more and more about the scan. So for the audience listening, we’ll get all into the nitty gritty of the scan, what it means, who might be interested today. But before we do that, I’d love to hear just a little bit more about you. I noticed you and I Both started at McKinsey. I spent seven years there. I think it’s a great jumping off platform for anything we want to do, even though we both wound up in different industries. So tell me a little bit about your background and how you got here.

Dr. Daniel Durand: Sure. You know, it’s funny that you say I start off in McKinsey because I it was my first job outside of academia, but I felt like a pretty well formed adult at the time. And I was in my 30s by the time I worked for McKinsey as an associate, which is a bit later than most because I went took that role after having been on instructor level faculty at Hopkins. So kind of getting back to where I started. I grew up in Long Island. I went to public school for high school, went to Wake Forest on undergraduate, and then I spent a lot of time at Hopkins. As often happens, I went there for med school. I did some extra research on top of that. I then stayed there for internship, residency and fellowship. And then during fellowship also served as a junior faculty member as an instructor. And then at that point I went and worked, as you mentioned, for McKinsey and I did that to learn more about kind of real world implementation and change management. This was right around the time of the Affordable Care act and everything was changing in healthcare in big ways. And a lot of that change was coming out of D.C. and in and around D.C. there are these consultancies like McKinsey’s that get very involved at both the nonprofit, private and public level. So I had a chance to work for all three of those types of entities while I was with McKinsey and I became very focused on value based care, things like population health and screening, and decided I wanted to do more on that. So I joined a startup called Evolent Health that was focused on what we call ACOs and insurance plans and worked with Evelyn for two years up until the time that they were about to go public and grew that organization significantly as a member of the executive leadership team and grew out their physician consulting arm. And then I went back to work at Hopkins for a year running their Accountable Care organization as their first director of Accountable care within Johns Hopkins Healthcare, which is their insurance arm. And then also was an adjunct professor of radiology during that period. And then I got a really interesting offer from across town. It was a health system that is historically associated with Hopkins that later became the site of the regional campus for George Washington University. And this is called lifebridge Health and it’s a place where I had done a lot of my medical student rotations. So it was a chance to be a leader at an organization I trained at. So I lateraled over to lifebridge and I ran a variety of different things to them over about a decade. I was initially chair of radiology and over their clinically integrated network. I then became their chief innovation officer for a few years and did all of their digital health and some of their early AI and a lot of their research infrastructure as well. Started up a couple of incubators startup incubators in digital health and the life sciences. And then I became their chief clinical officer for a period of time being over there all of their ambulatory, clinically integrated network. And about six months ago I decided to come over to Purnuvo and again, I think it was just another step forward because LifeBridge was a regional organization and Pernuvo is really a global organization. It is just kind of starting and getting going. But we have clinics in Canada and the U.S. and we’re expanding to new states every month and we’re going to be expanding to new countries every few months starting very soon. And and so that was what drew me was both the mission and the chance for a broader impact.

Megan Lyons: So basically, in a nutshell, you’ve had a really boring and non impactful career trajectory, is that right?

Dr. Daniel Durand: That’s about right.

Megan Lyons: I’m kidding, of course. That’s so impressive. You could have a movie script. Just about all of the things that you’ve accomplished and all the ways you’ve given back. That’s really incredible. So thank you for the work that you’ve done and particularly since I’m most familiar with it, thank you for the work work that you’re doing at Prenuvo. I think like I mentioned in the intro, I first found out about this several years ago right when it was probably emerging to the. The broader public. And I was like, ooh, that’s interesting, but it’s a little expensive. Let me put it off on the list of I’ll do that in the future. And then the more and more I learned, it became something for me that was like, these benefits outweigh the cost. Yes, the cost is not just a cup of coffee, but the benefits are so great that I want to experience that for myself. So, like most things that I bring onto the podcast, I did it myself in early 2024. It was a great experience, and I’m excited to share more with the audience. For those who have never heard about the scan before, can you just give us the starting background to what it is?

Dr. Daniel Durand: Yes. Prenuvo is like being digitized right, in an MRI machine and then seen by a type of physician that’s called a radiologist. And in this particular context, they’re looking at your whole body. So it’s kind of like seeing what we call a primary care radiologist. And we do it in such a way that there’s no radiation involved. So when people hear radiology, they think about radiation. They think about something that can, in certain. Certain circumstances, you know, increase your cancer risk a little bit. And so we managed to do this with an MRI machine where there is no radiation whatsoever. And we also don’t inject any dye, any contrast dye, which is something people sometimes need to get when they. When they get a scan. And so that means they don’t have to get an IV either. So the only thing someone has to do to get this scan is come in and lie down and go inside the MRI machine. And for that reason, you know, we’ve lowered some of these barriers and anxiety to getting seen. Right. And seen by this type of doctor. And I say primary care radiology because we are not trying to replace primary care, but we’re trying to do that annual physical that primary care doctors have done forever. We’re trying to do it for the inside of your body. Now, when a primary care doctor sees you, and someone, if they know a primary care doctor, can feel free to ask them about this, they can see stuff on their outside of your body and feel stuff on the outside of your body that can tell them a little bit about what’s going on inside. But typically, by the time they’re seeing changes on the outside or feeling something big enough for them to feel through the body wall, that process has been going on for a while. And if that process is like a disease or a cancer that’s. You don’t want to pick up on it later, you want to pick up on it earlier. So the principle of prenuvo is looking inside the body and telling the patient everything that we see there. It’s democratizing this information. And there are two kind of historical analogies I like to draw to this, and it kind of gives some insight into, honestly, what some of the concerns and some of the detractors of Pernuva might say. The one thing is that we are looking where other people haven’t typically looked. Right. We’re looking up front. And in that sense, we’re kind of like Galileo. You know, he’s pointing his telescope out there and he was making observations right during the early Renaissance. And. And this bothered some people because it proved he could prove that the planet circled the sun and the Earth was one of them. And I think part of what we’re doing by looking up front on behalf of patients, we’re making healthcare circle the patient. Right. Instead of circle the doctor or the insurance company. And that’s shaking things up. So that bothers people. Another thing we’re doing is the democratization of the information. We’re putting it right in the patient’s hands. We’re telling them what’s going on. And that’s a bit like Gutenberg. So Gutenberg was the person who created the printing press, you know, published a lot of Bibles at first, because that was the main book around back then. And again, it kind of drove people crazy. They said, what are you doing? What are you telling people, you know, what’s, you know, printing the Bible out for? They should be hearing that from someone who knows exactly what happened there. They shouldn’t be forming their own conclusions. And I feel like we’re hearing the same thing from some physicians that don’t like Pernuvo. They’re just saying, look, these patients have no business knowing this information. You’re just going to make him anxious. Let him hear it only through doctors. But, you know, that’s not what we’re doing. We’re choosing to democratize the information.

Megan Lyons: Yeah, the listeners who have been around for a while will probably be nodding vehemently because I have a strong passion to allow people to see their blood work data, their stool data, like whatever data they really feel is necessary for them to improve their health. I think as. As individuals, we deserve that data. And you’re going a huge step further and offering this big technology that would be way inaccessible for most people. So I think the detractors will eventually have to Come around, we’ll see where it goes. But this whole thing is in the field of proactive health or preventative care. I would love for you just to touch on that, why you’re so interested in preventative care. What are the advantages of doing this now before waiting for, quote, real symptoms to arise? Anything you want around that area?

Dr. Daniel Durand: Well, in about 1 in 20 patients, when we look, we find something that means they should see a doctor fairly soon. And there are kind of three classes of the most common findings. One is we can find something that might be cancer and about something around half the time that we see it. Based on the biggest study we’ve done, it does turn out to be a cancer. And so depending, it really depends on the location that we’re talking about and the age group of people seeking care. But in the largest study we’ve done so far, about 3.9% of patients had some sort of mass. And when they worked it up, 2.2% wound up having a cancer diagnosis. And the majority of those diagnoses were early on in that study. And that’s when you want to get it, when you leave the world to its own devices. Most people present with cancer and in the later stages, three or four. Which is one of the reasons we believe at prenuvo that we have this societal attitude towards cancer. You know, that it’s inherently scary because if you’re finding out about it late, it often doesn’t have the rest of the story doesn’t go the way you’d like. But if we usually found it at one or two, we might have a very different opinion of this and approach it differently and want to know about it. In fact. And the second class of findings are aneurysms. So if anyone, it’s a little bit more rare than a cancer death. But most people know someone who has died of an aneurysm bursting either in their abdomen, their chest, or in their br. And we see aneurysms in the brain about 2% of the time, and only a fraction of those need intervention. But all of them need to be followed to see if they do grow into something that needs to be intervened upon. And we also see aneurysms in the other parts of the body I mentioned, mainly the abdomen and the chest. And all of those would need specialist follow up. And we usually say sooner rather than later, you know, just to get ahead of the issue. And then there’s metabolic disease. We see a lot of people with fatty liver disease. Something like one in five will have this. But a Subset will have severe fatty liver disease closer to 2%. And that severe fatty liver disease is part of an ongoing epidemic in our society of something called non alcoholic steatohepatitis. And this is basically the idea that if your body’s storing a lot of fat and starts to put in your liver, that your liver can then react and start to fibrose and you wind up with cirrhosis, similar to if you had had a viral hepatitis or an exposure like alcohol or other things, but not caused by either of those. And so this is something we’re seeing more and more of as a society. And when the, the important thing is when you intervene early, early enough on this, it’s, it’s felt that you can reverse those changes and not progress to a bad outcome. So those are three examples. Now people always want to know. They say you can diagnose 500 plus conditions. Right. And you know, where does that list come from and which are the ones you see? Those are the three I mentioned that the most serious we see the most of there is a huge long tail of others that we see. And most people, when they come for their first scan, will learn something important. They might learn something important about the way their body is formed. And I’ll give you an example. They might learn that they have only one kidney or something like that. They might learn they have one of these serious conditions that I mentioned. They might learn they have something in between like a mild fatty liver disease or gallstones or kidney stones, or they might learn they have a small infection in their lung that they, you know, they should get treated but isn’t causing them symptoms. So there’s, we can sit here and we have to talk for hours to talk about all the different ways we’ve helped people. The other thing they might find is that their, their body shows signs of aging that is above and beyond their, their chronological age. Right. And that’s something that we’re, we’re just starting to scratch the surface of in medicine with all the functional labs you mentioned, as well as the imaging and medicine. Right now, I think it is, it’s sort of figuring out what to do with this. We’re building these models of healthy aging biochemically and on and with imaging so that we can identify people that are aging too fast and figure out what interventions they can do to try to slow that aging.

Megan Lyons: So fascinating. I love this. I have so many questions, but I’ll narrow it down to two. One is more of a comment that was one of the more useful actually. The whole thing was useful, but one finding from my own scan was some degeneration of some of the discs in my upper spine. And I know I’ve always had neck pain for the past, I don’t know, couple of years, but seeing that on paper was like, oh, okay, you’re not making this up. Maybe there are some adjustments you need to make to your posture, or maybe there are some physical therapy exercises you can go through. The point that I’m making is just seeing it in a result can spur people to action, even if it’s not something super serious. I think getting that data is so, so important. And then confirming there were some other things that I was aware of in my body, confirming that they were all under control. And all of that’s just extremely useful, even in the cases or potentially especially. Well, not especially even in the cases when we don’t find something surprising. So all that said, you’re mentioning the. The liver, fatty liver conditions, the cardiovascular, the aneurysms, everything that you. Cancer, of course, you mentioned. Who would you say is the prime population that would benefit most from a scan.

Dr. Daniel Durand: That’s a very good question. We have two populations we tend to see. We have people who are getting the scan to be proactive, and that’s the majority of people, we’ll say 80%. And within that, there’s sort of two subpopulations. One are people that are being proactive purely for the purposes of being proactive. In other words, they don’t have any special reason to think that they are greater or less risk for various different diseases. They just want to get ahead of the game. And I honestly think that mentality is beneficial for anybody in any age group. But where we see this most common makes sense if you think about the stages of life. We see it in what the population, health community calls the rising risk population. So these are people who have the sort of time and attention to start to focus on their health and the reason to do it. So they are aging. Right. But they haven’t picked up so many chronic conditions that those are now the focus of what they’re doing. So if you have COPD and diabetes, you probably should spend a lot of your time optimizing around those conditions rather than necessarily looking for other things. Right. I think you should be proactive once you. Once you get on top of those. But in the rising risk crowd, these are people that don’t already have medical conditions. They are aging. And a lot of them have families, right? Family members, kids, depending on them, et cetera, sometimes. And so there’s a reason for them to really want to preserve their own functionality and longevity, like beyond just their own. Their. Their own, you know, focus on themselves. It’s a focus on their family. And so that’s the age groups of the 30s, 40s, and 50s. That’s where we often think about rising risk. And in healthier individuals, you can be rising risk and be in your 60s, 70s, and even early 80s. I’m very proud of. I would say my, my mom is in that sort of like, you know, really rising risk in the sense that she’s in the late 70s and doesn’t really have any major issues. And like, that’s. That. That’s because she’s proactive, you know, so. So that’s who we, I think, help out the most. But we can help anyone at any walk of life get ahead of their issues. The, the other part of that proactive crowd is people who have a special reason to think they’re. That they’re at increased risk. And this is a crowd like, if we have people coming in there, it’s a little more enriched in their 20s and 30s. They are not going to wait for the cancer screenings that are prescribed and widely recommended, all of which we support. So I’ll say it at least once in this conversation. Prenuvo does not replace primary care, and Prenuva does not replace any of the USPTF guidelines. In fact, we augment. Right. We recommend in our interactions with patients that they do both of those things. Because what we do works best for the patient when they do those other things.

Megan Lyons: Yes.

Dr. Daniel Durand: However, for people with, you know, certain familial conditions or just exposures in their occupation, maybe veterans, burn pit survivors, people that have a good reason to think that they’re increased risk for cancer or maybe other conditions, they come to us to get. To get a screening that doesn’t have any radiation or contrast associated with it, to get that earlier than they would otherwise, maybe get it covered by their insurance. So Those are the two populations that are proactive. Then we have about 20% of patients that are. They’re having some kind of symptoms, but they don’t localize to any one part of the body, any one organ system. Often they’ve had several doctors look at them. Often they’ve had several different types of prior imaging studies. And so this is a sort of like, Dr. House aspect of what we do. So we are literally putting them into a very powerful diagnostic modality, you know, where we’re looking through their entire body and we might be looking through it like I Said we’re looking in an hour through the entire body. So we’re not going to look at the pancreas the same way as someone does if they just look at the pancreas for 45 minutes. But we look at the whole body, we look at the pancreas very well. Right. And so often by looking at the whole body and looking at each part, you know, high enough to detect abnormal from normal, we’re able to pick up on patterns that show multi systemic diseases, things like, let’s say rheumatoid arthritis or an inflammatory bowel disease. We’re sometimes endometriosis, we’re sometimes able to pick up on these things and they’ve been missed before. Right. And so that’s a very exciting part of what we do as well. But it is, it’s a minority of the people that see us more like the 20% rather than the 80 that are being proactive.

Megan Lyons: Well, everyone listening, I can almost guarantee is nodding their heads because that first group that you described, that’s the, the primary audience here, where most of us are in our 30s, 40s and 50s, not having anything, knock on wood, and thank goodness to our healthy lifestyle. That is of primary concern right now, but very proactive and wanting to make sure we don’t encounter that. So thank you for describing those groups. You did touch a little bit in your example of looking at the pancreas for 45 minutes versus the whole body for 60 minutes on the difference of technology. So, so without getting super, super detailed, can you just explain how your MRI technology is different from a different mri and you could talk about your team of radiologists, anything you want here.

Dr. Daniel Durand: Absolutely. So I, there’s, there’s sort of three principles when it comes to getting the data really well. There’s the machines that you use and the way they’re configured. Right. So kind of like if you have a car, you might have, let’s say a certain model of, I don’t know, say Tesla just for fun here. But you can put all sorts of different extras on them. Right. So MRI scanners are like that. There’s a basic type that you buy and there’s the extra little bells and whistles you put in it called the configuration. The second part of the process is the technologist, the person who’s actually overseeing the acquisition of the data and the scan. And then the last part is the medical part. Part of that is, is the radiologist looking over the images and interpreting. And then there’s another part where there’s a practitioner that Actually directly engages with the patient or their doctor, depending on the, on the, what’s, depending on the care model and then and tells them what’s going on and kind of gives them insights. So I’m going to go through each of these three and talk about why Prenuvo is, is different and differentiated. We’ve been doing what we do for 15 years as a clinic and for six years as a company. So we’re the largest company I’m aware of in the world with the most experience focused specifically on whole body MRI for screening. And that’s a big deal because you learn a lot in 15 years. That optimizes each of these three parts of the process, especially the upfront part. We know exactly because we know the type of image we want and what we’re going to do with them and how we’re going to have the interactions with patients because we’ve been doing it for 15 years. We build a scanner to spec. So we work with device manufacturers that are FDA approved and we have them build a very specific type of machine for us. And it’s on the level of what you’d see with so called research magnet or a research type scanner at a major university. We choose 1.5 Tesla. And this confused a lot of people because they said, well, you know, I read somewhere that there’s a 7 Tesla scanner at a couple of academic centers and you know, there’s a, a company called United Imaging that has a five Tesla scanner and there’s lots of three Tesla scanners out there. Isn’t more Tesla better? And you know, and the answer is not really for certain types of applications more Tesla can help, but for some of the most important types of imaging for whole body, it doesn’t help actually. So we found that for the diffusion weighted sequence, and this is the sequence that lets us find things like inflammation, infection and neoplasm or cancer. This sequence is showing you pathology. It works better and more consistently at 1.5. And so it’s not just Pernuvo. Many of the organizations that have done a lot of whole body MRI say the same about this. So our machines are built to spec and they’re built a certain way and then we’ve optimized our sequences. It’s kind of like a recipe. So like we’re a restaurant that’s been making whole body, you know, for 15 years and our recipes are just a little more advanced than if you go down the street. And some really good local group of radiologists has decided in the last six months they want to start doing this. The second piece is the technologists. And this is really what happens in the center that’s depicted, you know, around me, where folks can’t see it at home. But I, you know, in our centers, which are very peaceful and spa like in the back, they’re also very, I would say, regimented in medical in the back area. And the way that those technologists bring the patients in, position them and get the perfect images, they are really good at that because they do it as their full time job. And if they were in a different practice, they might be doing five knee MRIs, two head MRIs, a spine MRI and then squeezing a whole body in. You’re just not going to get as good. Okay, so our process is really refined. We’re doing over a thousand of these a week. We’re doing a lot across the country. And our technologists, their full time job is to do this type of scan. And then lastly, similarly, when it comes to reading it, our radiologists, they work on an IT platform that lets them work from the comfort of their home and they can read these images. It takes about a full hour to read each scan. Our Scans have about 2 to 3,000 images, depending on the type ordered and the size of the patient. So our radiologists are given a full hour to read through that and they proceed through a structured form so that every one of these things is read exactly the same by our 80 plus board certified radiologists. And that is unique, right, because structured reporting is something that everybody sort of would say they support in radiology. But very few practices can get people to do it this way to get professionals to do their jobs like the same exact way. But we only hire people when they agree to do that. And it lets us be really good about not missing stuff. So if you had a home inspection, right, and the guy just kind of came in, he was super experienced home inspector and he walked around, he said this place is fine. You’d be like, yeah, like, oh, that’s weird. The last home inspector that came that I use on my other house gave me like a 40 page report. Can you, can you tell me a little more than fine? Right. And that’s sort of like where we are at Renuva, we give that 40 page report and it, and it is done the same way every time with a high amount of structure. And then we have a team of primary care providers and nurse practitioners that actually walk through these results with patients along with an app that they find very relatable that shows them their key images of anything Abnormal. They have along with again, that checklist that goes through their whole body and tells them this system’s fine, this system’s fine. This system has a finding in it. It’s either serious and you need to see somebody soon, or hopefully not, you know, or it’s just informational or something that needs follow up but isn’t super serious. So those are the types of ways that we convey information to people. And I mentioned, I’ll just say one more time, we have 80 plus radiologists that work with us. More and more of those are full time. I think by the end of the year, we’re going to be up to 30 that are full time. All of them are, whether they’re part time or full time, they’re all board certified. And that is very rare. You don’t get board certification until you’ve first of all pass all the tests, but second of all, been out of residency for at least a year. And in this environment, most practices, even very prestigious ones, are having people that are board eligible read for them, but not yet board certified. We only do board certified. The vast majority of them have fellowships. Some have two fellowships. We have a broad variety of fellowship training within the practice and that people can consult each other since they’re doing full body. So if someone’s a primary neuroradiologist that’s reading something and they see something in the shoulder, they’re able to reach out to someone who did a musculoskeletal fellowship immediately and loop them in that case. So it’s kind of like we have internal consultations and a community of learning that makes sure that we bring the very best to each organ system that we’re looking at. And in the past year or so, we also have started publishing some of our work scientifically and also publishing some of the casework that we’re doing. And I think it’s opening people’s eyes because we get more and more inquiries every week like, can I come work for Prenuvo? This seems like a really cool way of practicing radiology.

Megan Lyons: Wow. So clearly in your role as chief medical officer, you are doing the utmost to make sure that the education, the technology, the standards, the unification, all of that is there. And I will echo what you said, the reporting, the consumer facing reporting is excellent. I found it very easy to navigate, very complete. As a data lover, I want to see everything, even the things that were good. I want to see confirmation that that was good. And I found that very accessible and helpful. So you’re doing a great job there as I talk to people about this. I, I hear probably the number one comment is I totally want to find something if there’s something there, but I’m scared of finding something that’s not actually there. And with any scan, this is a real concern. So how do you address the fear around false positives?

Dr. Daniel Durand: Well, I think not just with scans. Right. Anytime anxiety can be introduced, anytime that you seek new information about anything in your life, Right?

Megan Lyons: Yes.

Dr. Daniel Durand: So the first day you send your kids off to school, they’re going to be anxious and they could learn stuff that could make them anxious. Right. They could find out Santa Claus, you know, isn’t real. Right. I mean, there’s all sorts of things that introduce anxiety that we just realize are part of a healthy process in life.

Megan Lyons: Yeah.

Dr. Daniel Durand: And I think false positives, what gets called false positives is kind of along those lines because some people would call a false positive anything we find that doesn’t need, like surgery or treatment. And we reject that notion, this idea of incidental findings. We believe that if somebody has one kidney, that’s not a false positive. That is something that is informationally and potentially important for them to know. If they have a lesion on their kidney that turns out not to be cancerous, that is important for them to know why. Well, first of all, it’s inside of them and you want to make sure that it isn’t worrisome. But beyond that, we’re all growing up and growing older in Western society. All of us, as we get sick, will be imaged head to toe in an emergency room at some point. And if we know what’s inside of us, then that healthcare team who’s trying to take care of us in that instant when we really need it are not going to be confused by these things. If we have longitudinal data showing what’s been inside of us all along, and that is a very important topic that I think people aren’t paying enough attention to because I think people just don’t understand that every. We live in a body scanning society. Talk to anyone alert works in an emergency room. As time goes on, the radiation dose goes down on CT scanners. The electronic ordering systems make it easier to order. More and more nurse practitioners and other extenders are being used to see patients up front and they’re usually, they’re more protocol driven and they, so they, they image more than the traditional ER physicians. So in our society, this is how we work people up and we think there’s benefit to pulling that forward and doing it without radiation beforehand. So we don’t think all these are false positives. Now I’m not saying there’s no such thing as a false positive. Every test, every encounter has a potential false positive. If you go to the primary care doctor and the primary, which you absolutely should do, no one would say, you shouldn’t do this. And he or she looks you over and says, hey, you have a mole on your shoulder. I’m not a dermatologist, I’d like one to look at it. And then you go to the dermatologist and they look at it and they say, I think you’re fine. Was that a false positive? Most people would say, no, I have a really like thorough primary care doctor. They did a full exam and they were concerned, but then it turned out to be nothing serious. So that’s, I raised that by analogy because when we’re looking on our kind of whole body survey scan and we see something that’s let’s again, we’ll go back to the kidney that’s in the kidney, we say, someone should look closer at that. And then we get a follow up MRI scan of the kidney and it turns out to be benign. We think we’ve done the patient a service the same way that primary care doctor that referred to the dermatologist did. We don’t see that any differently. We don’t consider that to be a false positive. Now if we raise something, if we raise a concern about something, and just like that, primary care doctor, let’s say the dermatologist says, I don’t know either, let’s get a biopsy. Now you have two possibilities, right? Biopsy was negative. Well, that would be a false positive and it would be shared by both the dermatologist and the primary care doctor. Similarly for us, if we see something and then it gets imaged by another group and they also think it’s concerning or even more concerning and it gets biopsied, that would be a false positive if it’s not cancer. But again, it’s shared by more than one provider, not just by pernuvo. But like I said, we do very well when we look at who gets biopsied in the sense that the data we have shows that most of the biopsies, or about half of them, wind up really being cancer. And that compares very well to some other methods that are not controversial. Right? So if you look at mammography, well below 50% of lesions that get biopsied wind up being cancer. And I’m not saying anything negative about mammography, I’m just saying, you know, that you wouldn’t not get your mammogram for this concern. And I don’t think it should dissuade people from coming to see Pernuvo.

Megan Lyons: I love the analogy of the mole on the shoulder. I think that will click in with people a lot. It’s absolutely true. And as a data lover, I have a whole lot more anxiety not knowing than knowing. So if we can reframe it, we as the audience can reframe it to. I’m giving myself the gift of catching anything in there early and worst case scenario, I get a second opinion and I don’t have to do anything about it. Well, that’s a win right there. The knowledge is power and like you said, we will all be imaged. So knowing a starting place is such a huge benefit. Go ahead.

Dr. Daniel Durand: I mean, it’s, I love to hear what you said and there are people that would listen to what you just said, right. And they would classify you and me right along with you because I think we’re pretty similar. And they would say, well, you’re the worried well. And I said, well, you know, when, when, when the worried well person gets their annual mammogram and goes, sees a primary care doctor, they call them a good compliant patient.

Megan Lyons: Right.

Dr. Daniel Durand: They go the extra mile beyond the guidelines in this new democratized era of wellness and consumer driven healthcare, then they start calling us worry well. And I think they need to realize, listen, the people that you’re really happy with that actually are compliant. We’re the same people. Stop, you know, stop using this worried well as sort of some sort of derogatory term because most people who are well and are consistently well over time, they have a little function of that extra anxiety and worry in them and that’s what makes them well. So don’t criticize it so much. You know, I think people, it’s not like folks like you and I are up all night unable to sleep, encountering health problems over this. There may stuff that are like that, but that’s not, that’s not everyone who’s seeking these services. And I think there’s a lot of misunderstanding of that and I think so anytime you hear the term worried well folks on, on online as well, just ask that person, well, you know, aren’t they just a compliant what if they’re just a compliant patient going the extra mile just, you know, tease that apart from worried well. And what those people ultimately going to say is listen, unless I tell you to do it, you’re worried well. And I reject that. Right. I just don’t think we know as doctors that we should be so paternalistic.

Megan Lyons: I love it. I think unfortunately the, the normal or the average is the unworried or the oblivious unwell. And if we’re comparing us as the quote, worried well to that, well, gosh, I’d rather be in this camp than the, the oblivious unwell. So very good call out there. Now, I’m confident people are already excited about doing this, but maybe appropriately have a little trepidation around what’s actually going to happen. So you said it’s very professional, it’s very medical, it’s very comfortable. Walk us through the process of getting a scan from start to finish.

Dr. Daniel Durand: Yeah. It begins by either calling or more commonly going to the website and booking online. And then we will have folks that reach out to you and they make sure that you’re appropriate for the scan. They’re going to ask you why you’re getting the scan. If you say something like, hey, my, I twisted my ankle last week, they’re going to say, hey, this is, you know, your insurance will probably cover like a regular. Just MRI the ankle. Don’t, don’t come to us for that. So they’re going to make sure that you fall into one of those three buckets that we already talked about in whom we feel that the scan is appropriate. And the second thing that’ll then happen is they’ll ask you some questions that are about your safety in an MRI machine and those are going to be repeated later on. Sometimes I mentioned this to everyone about the experience. Sometimes it drives people crazy. They don’t like to be asked like the same question a bunch of times in healthcare. And I’m overall kind of for that. If I’m asking your birth date like nine times. But, you know, for the MRI safety questions, we are going to ask them a few times because that’s like the, the only risk to this is if we put you in there and you have some kind of metal and you don’t belong in there. So we really make sure that you’re not, that you’re safe for it. You don’t have any reason that you shouldn’t be in an MRI machine. Once we’ve cleared all that, you’re then going to get some emails and be asked to download the app. And the emails will basically say, here’s when your appointment time is and here’s where the center is. And you’re not supposed to eat for four hours before the exam. And folks come in at that point and they’re going to be Greeted by a really calming place that doesn’t seem much like a doctor’s office or a waiting room. And they’re not going to spend much time in this sort of welcoming area because we’ll very quickly get them back to a space that’s entirely their own, that’s like a dressing area. And usually within like, 30 minutes of arrival there or less, they’re back in that other area. And I mentioned they’ll get that additional set of screener questions and then be brought back to the scanner. One point left out is before they come to the center, they’ll get a broader medical intake form to fill out. And most people enjoy filling this out. Some people feel like they don’t want to give a bunch of information. The more information we have, the better a doctor we’re going to be for you. Right? Because by giving more information, it gives the radiologist more context. It’s not as if we see a bunch of ones and zeros and there’s a mathematical equation that gets us from the image to exactly what’s going on. There are certain things that if we see them, we know are happening, but there are other things that are more clues. So if we have a broader and more thorough medical history, we’re going to be better at contextualizing the information just like any other doctor. So they filled out that form, they came to the center, they got rescreened, they went to the dressing room. Now they’re back in the MRI scanner area. And the technologist will kind of. They’ll put a set of coils over their body, which makes sure that we get the best possible images. And they put the patient into the machine, and the patient has something over their head that lets them. It’s a system of mirrors that actually lets them watch TV while they’re in the scanner. And this is important for two reasons. For people that get bored, it’s just important to have something to do. Right. I think that’s most people. For people like myself that are, like, not really claustrophobic but don’t love tight spaces. That set of glasses, to me, it makes the machine, like, open up. Like, I don’t feel like I’m in a narrow thing. If I really focus on the mirror as I’m coming back into the scanner, it, like, opens. It kind of, like, opens up behind me, and I’m. And I’m seeing, like, a landscape, LCD plasma TV or something that’s. Or LED TV that’s well beyond the magnet area. Right. It’s in a safe place. But I can See all the light from it. So I like that because that is a very unique setup. I mean, Pernuvo created this. I haven’t seen this in any other place. And you really feel like you’re not an MRI machine when you’re getting the scan. You do hear the noises. Like the noises, we can’t get rid of those. Nobody can entirely get rid of MRI noises yet. The scan takes about 40 to 50 minutes, and then once it’s done, you come out of the machine and you go home. You can stay at the center for a bit if you want. And we have lots of healthy snacks and good books on healthcare to read. But most people within an hour or so of getting the scan will go home. And then within usually three to five days, they will hear back from us that their report’s ready and they’ll get the opportunity to go through it with a primary care provider, either a nurse practitioner or a primary care doctor. And, you know, usually that’s the end of the encounter. Sometimes if there’s an urgent finding, like something super worrisome, we might call right after the scan, you know, or we might call a little in advance and say, hey, we have a finding we want to talk to you about. So sometimes we’ll have the conversation before the information’s pushed to the app if it’s particularly troublesome news. But you know, there, if we have to give them the information like everybody else within a 24 hour period. There are actually federal laws now that you reference that, reference what you talked about before, which is people used to keep the, the imaging and the blood test data with the provider, you know, until the doctor told you. But there’s a, there is like laws now that say you have to tell the patient which, and we support that. It’s part of this democratization of healthcare. So we always make sure the information gets to the patient and if it’s urgent, we make, you know, extra effort to, to do it verbally. But sometimes it has to, you know, it, it, it just, it’s like anybody else. Just like other places with electronic records and we can’t get in touch with the patient, it will sometimes just need to be pushed to the, to the application.

Megan Lyons: Amazing. My experience was precisely like what you just said. So everything I will corroborate, at least as an n of 1. The funny thing that I was chuckling about is I’m not claustrophobic at all. In fact, I was quite looking forward to the opportunity to do nothing with my brain for an hour. So I told the technician There. I don’t want to watch anything. I don’t want to watch tv. Can you just like put some meditation music on? And she kind of looked at me like I had three heads. Like no one has ever asked that before. But it was a very pleasant experience for me to just zone out there. So if you’re more of a TV person, you can watch TV but otherwise just zone out, relax, enjoy that hour off. It was very nice. So as we wrap up, I have a couple questions about where we’re going in the future. Where you are going in the future. I’d love to hear two things. Number one, what you’re doing to ensure accessibility to people in the future. And then just think big. Where do you see prenuvo in the next five or 10 years?

Dr. Daniel Durand: So the first question, we are running what I believe to be the largest whole body MRI research study ever in the state of Massachusetts. Like, like ever in the world. But we’re doing it in the state of Massachusetts.

Megan Lyons: Wow.

Dr. Daniel Durand: And we’ve currently enrolled over 500 patients in this. I don’t know the exact number. I know it’s over 500. And the goal is to get, you know, I, I think to. The goal is eventually get to a hundred thousand patients, I believe.

Megan Lyons: Wow.

Dr. Daniel Durand: Over a long period of time. You know, this is going to take us like a decade. And we’re going to learn a lot, you know, in the 500 we’ve done. We’re going to learn a lot in that group over time. And one of the features of this study is that those who can afford for it, afford it, pay for this, the scan. But those who cannot afford it, you know, either get 100% off or they get partial compensation depending on where they are in terms of percent of the federal poverty limit. And so this is again, to our knowledge, not only the largest whole body MRI study or projected to be, but also, I mean, I’m not aware of another health equity whole body MRI scan. So it’s really going to democratize this and bring in all kinds of pathology that we probably haven’t seen elsewhere because, you know, different socioeconomic groups may have different health issues. You know, and for example, you can imagine that over access issues there may be folks that have more advanced disease that we’re going to pick up on in the health equity group. You know, that that’s certainly something we’re looking for, but we haven’t, we haven’t enrolled enough people to make that conclusion yet. And we think it is a very important study because we want to prove out the utility of this to all of society. And we want to get the data on this to show if there are differences, you know, and there may be enhanced benefits. Right. For those that currently don’t have access to the technology.

Megan Lyons: Wow, really incredible. And then paint us a picture. Clearly don’t give us all of the plans, but something exciting in addition to the study that you can see prenuvo expanding to in the next decade.

Dr. Daniel Durand: So today we use artificial intelligence that’s primarily provided by the makers of the machines. So it’s FDA approved artificial intelligence that helps us acquire images faster. Right. At some point in the future, we’re going to begin using artificial intelligence that does more than that. And this is. So this is, I want to make very clear that this is a, this is not about a current state. Right. But this is about what we’re going to be doing, you know, let’s say two to five years in the future once there’s FDA approval around these methodologies which could be produced by us or others. But artificial intelligence is definitely going to make radiologists both more sensitive and specific. So we will be better able to pick up on lesions, less likely to miss things, and we will be more likely to, to identify something that isn’t a problem, that sort of is suspicious but shouldn’t, should be followed up just non invasively. Right. So we believe, and there’s evidence mounting from all sorts of different modalities, ultrasound, CT, MRI, that artificial intelligence can be used in both of these ways. And an additional way it will be of use, and we’ve done some really great research on this already and published quite a bit, is you can use artificial intelligence to make measurements through like tens of thousands of scans that create these aging models that I referred to before. So you can create an aging model for the brain, you can create an aging model for other parts of the body, like the kidney or the spine or the liver. And you can then take a given individual and not just talk about what their biochemical age is, but by organ system. By organ system and then focus them on where their aging is potentially occurring. So it might be that somebody has a good looking aging curve on the brain. Right. And all their internal organs looking good, but maybe it’s orthopedic for that person and their spine is the issue. Right. And then it becomes like a checklist for them and their primary care doctor or maybe a musculoskeletal physician to sort of say, well, what is it? You know, a couple things that. And we know there are risk factors for aging in the spine. So things like being overweight. Right. Certain types of activities, smoking, more so than drinking, actually tends to negatively impact spinal aging. Um, but this sort of preventative approach and maybe being able to say, Listen, from age 20 to 30, this person’s spine had accelerating aging. Like, we need to figure this out before they re have those herniated discs and everything else that requires a surgery in their 50s. Right. And this is a whole area of medicine that because it’s preventative, it doesn’t really exist today. Right. Not because we don’t have information on interventions, but it’s a little more that we don’t have information on the right biomarkers, we call them to use to, like, how to. How to assess the aging, how to put a number on it that’s quantitative and meaningful. And so that is a big part of what companies like. Like us will be able to offer people in the future.

Megan Lyons: Wow. Well, this is fantastic. You can count me in as a repeat customer. I will continue using the technology as it advances. And I did say this in the intro, but I want to remind the audience again that the company has been very kind to offer the listeners $300 off. If you want to get a prenuvo scan, you can use the code L Y O N S. We’ll put that in the show notes and in the closing as well. But I want to thank you, Dr. Durand, one more time for coming on wellness your way. Is there anything else you would like to leave the audience with as we close?

Dr. Daniel Durand: I would just say that in the interest of increasing accessibility, like you mentioned, that the discount, I think, will do that a little bit for your readers, for your. For your listeners. And, you know, at the end of the day, we’re a medical practice and we’re privileged to have the opportunity to care for anybody who comes into our practice. We, you know, we. We deeply value the. The opportunity to help people get ahead of the game in their health and, you know, get. The more that people get to know us, I think the more they’ll understand, you know, what it is we’re about.

Megan Lyons: Well, thank you once again for the work that you’re doing and for your time here today. We very much appreciate it.

Dr. Daniel Durand: Thank you, Megan. It’s been a pleasure.

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