The chamber of an MRI machine is a surreal environment. You’re flat on a slab and fed into a tube. Inside, it’s dark and noisy, intermittent reverberating around your head. I’ve always attributed this chaotic banging to atoms ricocheting, doing quantum stuff, rendering the invisible visible. Bones, organs, blood vessels exposed. Dodgy cell clusters held up to the light for a radiologist’s inspection. MRI is short for “magnetic resonance imaging,” so presumably magnets are involved. I don’t know how. I’m not a scientist. I do know I find getting an MRI an existentially jarring experience. Before the technician loads you into the machine, you are —an individual with ideas and plans and memories; inside the machine, you are a body.
I don’t like MRIs. And yet, on a gray day last December, I find myself at the clinic on 34th Street in New York City, a stone’s throw from the Penn Station train that will soon whisk me upstate, getting scanned head to toe for the hell of it. Because I want to peer into the black box of my body. Because I want to live. Prenuvo is the best known among a generation of biotech start-ups offering preventive whole-body scans. Its promise is that, by voluntarily submitting yourself to an MRI every year or so, you’ll be able to keep tabs on your health and catch maladies early, when they’re easy to treat or, better yet, reversible via lifestyle changes. This sounds so terribly logical—who wouldn’t rather discover a malignant tumor before it metastasizes?—that it’s tempting to wonder why no one thought of it before. Surely there’s no harm in giving people a God’s-eye view of their inner workings. That’s the pitch, anyway. And it’s been given credence by Prenuvo clients like TV presenter Maria Menounos, whose scan revealed her stage II pancreatic cancer. “Thank you @ prenuvo for catching this early enough to save my life,” she posted on Instagram in May 2023. A few months later, in August, Kim Kardashian did her own Prenuvo post, posing in scrubs pre-MRI for her 364 million Instagram followers. Predictably, about a zillion news stories followed, anointing the $2,500 scan a new luxury status symbol while also acknowledging the chorus of voices from the medical establishment warning that its benefits are dubious, at best.
“How is my health?” As Prenuvo CEO Andrew Lacy tells it, that was the simple question he asked himself after hitting his mid-40s. “There was no way to get a comprehensive answer,” he explains. The American medical system is not designed to supply an overview of well-being; “it’s very reactive,” as Lacy points out, and not particularly holistic. Most care originates with a specific complaint—nausea, dizziness, a weird bump, etc. You see a doctor, and the doctor orders tests. Separate complaints, separate doctors, and separate tests. Lacy wanted the big picture, a picture detailed enough that he’d be alerted to problems that were, as yet, asymptomatic. A new whole-body scanning technology developed by Rajpaul Attariwala, MD, PhD, seemed to fit the bill. “For the first time, I got to know the inner me,” Lacy recalls of his pilgrimage to Attariwala’s Vancouver clinic in 2018. “And I knew right away I wanted to bring that to the whole world.” Prenuvo, cofounded by Lacy and Attariwala later that year, now boasts nine locations across North America, with 10 more set to open soon. Demand is high. Apparently, a lot of people want an answer to the question “How is my health?” Deeper questions lurk behind that one—less technical, more along the lines of, “Am I okay?” Or, “If I okay, does that meaningfully correlate to my actual physical condition?” And: “If I’m okay, if there’s some part of me that is, on the sly, falling apart, is there something I can do to keep myself healthy in the short-term and also, maybe, in perpetuity?”
The allure of a Prenuvo scan is the hope that it could tip you off to just about anything in your body that might someday debilitate or kill you. According to the company, it covers 26 regions and organs in about an hour and screens for more than 500 conditions. It purportedly can detect most solid tumors at stage I, when they are typically asymptomatic, as well as aneurysms, signs of diseases like fatty liver, and compressions in the spinal column that—if left to progress—can lead to loss of mobility later in life. In fact, the scan is meant to be so good at identifying abnormalities, it’s inevitable that clients will be shown something that makes them go, “What’s that?” Which is where the controversy comes in. “The thing about these kinds of tests is they don’t see ‘cancer’—they see a spot,” says Rebecca Smith-Bindman, MD, director of the Radiology Outcomes Research Laboratory at the University of California, San Francisco. “A spot on the liver, a spot on the kidney, a spot on the lung. And then you have to get another test to see what that spot is. Maybe several tests.” Such tests can be high-risk: Smith-Bindman cites needle pancreas biopsy, which entails painstaking work deep inside the belly, to avoid, say, piercing a hole in the bowel. Or they may be dangerous in and of themselves, like CT scans that expose patients to high levels of radiation. In the end, much of this testing is likely to show that a suspect spot is, as Smith-Bindman puts it, “a nothing, not a something.” And, sure, there’s relief in that, she adds, but it comes at the cost of both money—charged to insurance, if you’re lucky—and time spent dreading that you might be in the grip of a deadly disease.
Smith-Bindman’s concerns are echoed by the American College of Radiology, which released a statement in April 2023 cautioning that whole-body scanning could lead to a raft of ambiguous findings that will “result in unnecessary follow-up testing and procedures.” But let’s set these worries aside for the moment and imagine a world of infinite medical resources, where money is no object and diligent doctors do excellent work under ideal circumstances—a rich person’s world, if you will. In that case, is it good to hunt down every errant cell? Can we really head off all degeneration and disease? What, in the grand scheme, are we asking for from new diagnostics like Prenuvo? When I pose this query to Smith-Bindman, her first response is a long sigh. “People are looking for a miracle, cures for cancers they may not even have,” she says finally. “They’re looking for eternal life.”
My own visit to Prenuvo went like this: I checked in, filled out a probing digital questionnaire—me, my lifestyle, my family medical history, etc.—then retreated to a changing room to put on scrubs. A technician led me to the MRI room and, before strapping me down, asked what I’d like to watch on Netflix. For some reason I chose “Frozen Worlds.” I was provided with headphones and a pair of mirrored sunglasses that reflected a computer screen playing Netflix into my field of vision. The polar vistas of “Frozen Worlds” unfurled before me as —the atoms or magnets or whatever got to work. For about an hour, I was pretty much just watching the show. Then, voilà, the MRI was complete, and I returned to the changing room to get dressed, grab my suitcase, and head off to catch my train. Anxiety set in around Yonkers. What on earth would I find out?
It took about two weeks to get my results; I spent them imagining possible futures undergoing chemotherapy, or living with an inoperable brain aneurysm, like a ticking bomb in my head. Meanwhile, when I told friends I’d had a Prenuvo scan, they expressed jealousy. “Are you afraid of something in particular?” I asked one notably fit pal. “Cancer,” he said. “Obviously.” The thing is, there’s no such thing as “cancer.” There are, as Smith-Bindman took pains to point out to me, and they come in various forms. Some are couch-potato cancers, mostly just loafing around. Others are fast-replicating, treatment-resistant ghouls. Experts debate whether certain tissue abnormalities called “cancer” should be given the name at all—to wit, DCIS, ductal carcinoma in situ, classified as stage 0 breast cancer, which Patricia Ganz, MD, director of cancer prevention and control research at the Jonsson Comprehensive Cancer Center at UCLA Health, has argued should be interpreted as a “condition that is close to a cancer diagnosis, but is not.” The designation is meaningful because, thanks in large part to early-detection technology, breast cancers can be overdiagnosed and overtreated, and also because finding out you have “cancer” of any kind takes a profound psychological toll. “Cancer,” writ large, is the name we give to fear.
Still, the desire is powerful. It’s a form of agency. By knowing, we feel we have the power to direct the course of our future health and arm ourselves for battle against our great foe, death. My Prenuvo-curious friend heard about whole-body scans on a podcast—Peter Attia’s maybe, he couldn’t recall. Something in the vast landscape of longevity-focused content that seems, increasingly, to be everywhere. Like me, he was keying into conversations about aging, and antiaging, as he settled into his 40s. “I go back and forth with it, because on one hand, it seems like there are these radical advances in understanding how aging works and how we can maybe slow the process down,” he told me. “And then, on the other hand, it might just be another form of self-optimization hysteria.”
The desire to ultraoptimize one’s health in order to live better for longer has given rise to a whole new range of products and services. Supposedly science-based supplements. Cryotherapy. The $23,000 Vitaeris 320 hyperbaric chamber that Kendall Jenner installed in her house. All aim to tackle aging at the cellular level. You can get an “aging wellness assessment” at a Modern Age medical clinic; book yourself into , the deluxe longevity spa in Ibiza conceived by author Mark Hyman, MD; or submit a saliva sample to Elysium Health and have it tell you your biological age. And then, of course, you may also want to invest in a Prenuvo scan, to find out what inside your body is betraying you, or seems likely to. “There are a lot of influencers talking about how you can stave off aging, like it’s a disease,” says codirector of Stanford’s Longevity Center and a specialist in geriatrics. Some of the research in that direction shows promise, she adds, but little is proven beyond conventional wisdom like “stay active.” “Avoiding a sedentary lifestyle, that’s more meaningful than any other single intervention,” Kado explains, going on to note that, on a macro level, the most influential factors in aging are what’s known in her profession as “the social determinants of health.” “If you live in an area with good access to nutrition, safe walking neighborhoods, and low stress, there are major benefits not just to life expectancy, but to quality of aging. And there’s no pill for that.”
There’s no test, either, aside from going outside and glancing around. Nor will a Prenuvo scan tell you if you live with a sense of purpose, embedded in a supportive community—as tends to be true of the spry centenarians residing in the world’s regions where people are unusually long-lived. “You have to look at the whole person,” says Kado. “But I can understand why people grab on to things, like these scans, that they think will make them age better. We wish we had more control than we do.” Kado is describing me. I’m at an age where I’m starting to feel like time is getting short. I’m constantly surveilling myself for signs of deterioration—my fussy knee, the lines on my forehead. What I probably should be doing is checking my bank balance, because if demographic trends are anything to go by, I’ll probably live to a ripe old age, and I’ll need to be able to pay for food and shelter and pastimes that keep my mind and body active. On average, Americans live 30 years longer now than we did in 1900, when life expectancy was 47. Forty-seven! The elderly are more numerous, and more visible, today than they used to be; some of them number among the most powerful people in the land. Personally, I’d like to age like a fine wine, and it’s dawned on me that that will come down in part to choices I make now. Maybe I’m glomming on to the antiaging messaging cluttering my feeds—thanks, algorithm!—and maybe I’ve been convinced I have more choice in the matter of how I age than I do. In any case, this vigilance is new. Until recently, my approach to my own health could best be described as “emoji shrug.”
A case in point. Several years ago I noticed I was having trouble zipping up my favorite jeans. I attributed this to menstrual bloat, at first, then to winter weight gain. I made some diet and exercise adjustments and lost a few pounds. No help. Soon I couldn’t zip up my jeans at all. Because it didn’t occur to me that “jeans don’t fit” could be a medical condition, I chalked this situation to things, like, shifting around. Because aging. A year later, at an overdue appointment with my gynecologist, I found out my belly was swelled by a sizable uterine fibroid—large enough that extraction entailed surgery. When I heard about Prenuvo, I thought about that fibroid. If I’d gotten a preventive scan when it was the size of a lemon seed, a simple outpatient procedure could have taken care of it. No general anesthesia, no painful recuperation. Also, my jeans would have fit.
My hope, when I made my Prenuvo appointment, was that I’d find problems like that, that I could nip in the bud. My fear, once I bracketed all the truly nightmarish scenarios, was that I’d encounter a scan freckled with iffy irregularities requiring, as Smith-Bindman had warned, a myriad of follow-ups. I began contemplating my deductible. I worried about finding good in-network doctors. The multiverse in my head expanded to include a possible future of waiting on hold with my insurer. “Anxieties around learning about your health have nothing to do with Prenuvo and everything to do with the medical system we have now,” says Lacy. “It makes us afraid of knowing what’s going on with our bodies. We’re trying to empower people.” Lacy wants to reorient the medical system toward prevention. And he wants, he says, to “redefine disease”—to make early detection and treatment so commonplace that people don’t freak out about diagnoses, they just get issues speedily resolved and move on. For that to happen, whole-body scanning can’t be a niche business, and to Lacy’s credit, he’s keen to bring costs down. Of course, that doesn’t answer Smith-Bindman’s concerns about follow-up testing, or address debates in the medical community about when and how to treat nascent illness, or help people navigate a world of uncertainty. And then, the question remains: Who pays for all of this? “They have to run the actuarials,” notes Eduardo Dolhun, MD, a family physician in San Francisco who describes himself as “very bullish” on Prenuvo, when asked whether he foresees whole-body MRIs getting covered by insurance. It takes a while for the medical system to metabolize disruption, he says; eventually, new interventions may shrink the overall spend on care—as Dolhun asserts, a whole-body scan is more efficient than several targeted ones—but at first, they come with an eye-popping price tag.
There’s another way of looking at my fibroid story. Back when the mass was in its lemon-seed era, I was a young freelance writer living paycheck to paycheck. Sometimes I had health insurance, sometimes not. Even a “simple outpatient procedure” might have been unaffordable. I avoided doctors both because I felt fine and because I couldn’t swing the cost. It’s possible I would have discovered that early-stage fibroid if I’d been going to the gynecologist on a yearly basis, as is advised. Viewed from that angle, I can’t help but wonder if we’re innovating solutions to the wrong problems here.
Andrea Schaffer has what I think of as the best-case/worst-case scenario for a Prenuvo patient: worst case because she had a walnut-size brain tumor behind her eye socket; best case because, thanks to the scan, she found out. Schaffer, a 44-year-old oncology nutrition consultant based in Arizona, had no pressing reason to book her Prenuvo appointment; her motivations were a family history of breast cancer and an instinct, after a stressful previous year, that she ought to refocus on her health. “I thought, I’d like to get a baseline scan, just so I know I’m good,” she recalls. The only thing “wrong” with Schaffer was her diminished sense of smell, which she assumed was a lingering effect of COVID-19. This, it turned out, was a symptom of the tumor. “My surgeon asked, ‘Are you absolutely sure you haven’t had any seizures? Because this tumor is compressing your hippocampus, and that disruption usually causes seizure. That’s how most people find out they have brain cancer,’ ” says Schaffer. “But not me. It was just the smell thing. And who knew?” Schaffer credits Prenuvo with saving her life. “If I’d just gotten a mammogram, I never would have known.”
Schaffer’s Prenuvo experience is atypical. But she is in certain respects the prototypical Prenuvo client—a person inclined to be proactive about her health who heard about the service listening to Attariwala on a podcast hosted by Dave Asprey, another thought leader in the longevity space. It’s also worth pointing out that Schaffer had COVID, no doubt heightening her sense of being vulnerable to disease. Who among us didn’t feel that way at some point during lockdown, or during the delta wave, or the omicron wave? Also, it was hard not to notice that COVID, in all its forms, reserved special viciousness for the elderly and infirm. Perhaps it’s not coincidental that antiaging discourse got zeitgeist-y in the pandemic’s aftermath. Perhaps we’re all feeling acute pressure not to get sick, and not to get old. Which is entirely comprehensible. But the antiaging rhetoric floating around has the rather nasty effect of making aging seem like a lifestyle choice when, let’s face it, it’s not. We all march to the drumbeat of time, and whether you age well or poorly is down in part to luck, or its opposite. Lots of people have had unhealthy lifestyles imposed on them—not everyone gets to live in neighborhoods with good access to nutrition, safe walking streets, and low stress. That was another population targeted by COVID: the poor. And if you push the lifestyle-choice logic out as far as it goes, you get to the imaginary country in Samuel Butler’s —yes, the novel whence the trendy wellness-focused grocery store takes its name—where illness is criminalized and virtue is health.
I’m healthy. After all my fingernail chewing, that was the takeaway from my Prenuvo scan. Spots here and there, but I was advised by Yosef Chodakiewitz, MD, one of Prenuvo’s lead radiologists, that they all seemed to fall into Smith-Bindman’s “nothing” category. I want to be very clear about this: Throughout my hour-long Zoom call with Chodakiewitz, going over my scan head to toe, he was diligent about putting me at ease; indicating “dilated perivascular space” in my brain, for example, he immediately stated that it was an “incidental” finding—not zero risk, but close. At no point did I feel compelled to seek further testing. “The vast majority of people who get this exam wind up having a sense of clarity and calm,” Lacy tells me, so maybe I’m unremarkable. I did feel calm. And something else, too, when Chodakiewitz complimented me on the excellent state of my spine—“very little cervical compression, for a woman your age.” I felt smug. A human machine in perfect working order, with bonus points for Pilates. I’m a winner. Good for me.
In her book Susan Sontag writes that “everyone who is born holds dual citizenship, to the kingdom of the well and the kingdom of the sick.” At some point in our lives, each of us will be forced to make our home in the latter territory, she adds, either for a short spell or on a long-term basis. The lucky among us will live long enough to get old. What Sontag leaves unsaid is the obvious point: At some point in our lives, each of us will die. Working on this story was not fun. I was forced to do medical research, which I dislike, and reckon with such unamusing topics as the dysfunctional American health care system and my own inevitable decline and death. As consolation, I turned toward the spiritual, seeking a sense of acceptance about matters beyond my control by reflecting on Buddhism’s five remembrances. So go the first three. Honestly, I wasn’t cheered. So, executing a complete reverse, I pivoted toward the material: I might never really know what was going on under my skin, and maybe I didn’t even want to know, but I could at least get a handle on what was happening at surface level. Thus, another scan—this one, the VISIA Complexion Analysis.
The VISIA scan preceded a facial at the Augustinus Bader outpost at The Webster, in SoHo. My friendly aesthetician, Desiree, directed me to a seat in front of a small machine, into which I inserted my head, as I do when I get my eyes checked at the optometrist. Here, instead of me reading blocks of tiny text, the machine was reading me, using cross-polarized and UV lighting (quantum stuff) to take subdermal 3D photos of my face. These were analyzed in terms of pore size, wrinkling, overall skin texture, and buildup, after which the software reported back that—sans Botox or filler—I look exactly as old as I am. This was mildly disappointing, but then, the whole point of the facial was to restore some youthful glow. An hour later, following gentle microdermabrasion, the massage-like application of luxe Augustinus Bader products, and 10 zoned-out minutes basking in blue light, I appeared ever-so-slightly younger, as if I’d snatched back a year from the steely grip of time. The effect was fleeting. What stayed with me, though, was an image I’d seen on the VISIA screen, an age progression that showed me my face at 80. There I was, eyes a bit sunken, jawline softened, skin a landscape of creases. I am of the nature to grow old, I thought, gazing for a brief interval into the future. And you know what? It didn’t look so bad.
