The Rise of the ‘Just in Case’ M.R.I.

A growing batch of companies give customers access to whatever medical tests they want — no doctor’s orders required.

Last year, Thomas Hogan, a Texas software C.E.O., began to experience gastrointestinal issues. During an M.R.I. scan clinicians discovered what they said was a benign cyst in his spleen; nothing to worry about. Still his discomfort continued.

A concerned friend booked Hogan, 66, an appointment with the personalized health start-up Prenuvo, which charged Hogan $2,500 for an additional 60-minute M.R.I. scan. Three days later, he was on the phone with a Prenuvo clinician.

“They said, ‘You need to get in to see an oncologist,’” Hogan recalled. “‘It would appear that you’ve got a tumor on your spleen.’” It was stage IV cancer.

Medical tests have become the next frontier of a growing obsession with personal wellness data. Just as wearable devices like the Oura Ring and Apple Watch have made it easy to track once esoteric stats like heart rate variability and blood oxygen levels, a new batch of companies allow customers to access tests like cholesterol levels, inflammation markers, gut-microbiome readouts and even full body M.R.I.s whenever they want them.

Occasionally, as in Hogan’s case, these tests can lead to a critical medical diagnosis. But some physicians warn that over-testing might lead to unnecessary medical interventions.

Regardless of whether or not it’s wise to sidestep your doctor, there’s a lot of money betting that demand for personalized medical testing will continue to grow.

The concept has attracted venture capital backing from the likes of Andreessen Horowitz. Famous entrepreneurs including Daniel Ek, who recently announced that he would step down as C.E.O. of Spotify, and John Mackey, the co-founder and former C.E.O. of Whole Foods, have founded personalized wellness companies. And some employers, including John Hancock Financial, the National Basketball Players Association and the city of Tempe, Ariz., now offer such testing services as a perk.

Offerings and price tags vary widely. Function Health, for example, sells $499 annual memberships for 100-plus “biomarker” tests, promising clients a digital dashboard of their own biology. (QuestDiagnostics actually conducts the tests for Function.) Prenuvo charges $2,500 for full-body M.R.I.s that aim to detect undiagnosed cancers, aneurysms and other silent killers. And Love.Life, a Los Angeles “holistic health and wellness club” backed by Mackey, goes even further, with memberships that can reach $25,000 a year and include blood tests, wellness coaching, yoga, pickleball, acupuncture, reiki and other offerings.

Typically, in-house clinicians analyze test results and suggest next steps (which may include reporting back to your doctor).

“It’s about shifting from a sick care model to a prevention and wellness model,” said Betsy Foster, the co-founder of Love.Life. “Right now, the model is broken and we’re doing it very differently so we can truly transform people’s lives.”

Companies that offer concierge medical testing often explicitly lean into frustration with the traditional health care system in their marketing. But the industry is also the product of what Jonathan Swerdlin, the founder of Function Health, deems “a cultural shift” toward wellness that began nearly two decades ago — Pilates, yoga, saunas, ice baths, ayahuasca retreats, MAHA. The Covid-19 pandemic accelerated this trend.

“Health has left the four walls of the doctor’s office,” Swerdlin said. “But wellness got to a place where it lacked scientific and medical rigor. We’re finally applying science to what people are trying to achieve, which is living a longer, healthier life.”

Critics of turning medical testing into a “choose your own adventure” service argue that too much wellness tracking could actually make you unwell. Even the data from an Oura Ring, a wearable that monitors sleep time and heart rate variability, can send users into anxiety spirals, according to some experts.

“‘Healthy’ people are not infrequently turned into ‘patients’ because of the detection of abnormalities that eventually prove to be false positives,” cautioned Dr. Thomas Kwee, a radiologist at the University Medical Center Groningen in the Netherlands, over email. (In that country, people cannot order diagnostic tests without a doctor’s visit, he added.)

If you look closely enough, almost everyone has something in their bodies that might appear off but is ultimately insignificant — a patch of scarring, a strange growth. Once you become aware of it, how do you proceed?

“Incidental findings of unclear significance often require other, sometimes risky tests like biopsies to resolve,” said Dr. Mike Pignone, a Duke University medical professor and former member of the U.S. Preventive Services Task Force. “Or they can’t be fully resolved and thus increase a patient’s anxiety and spending without health benefits.”

“We believe the bigger problem is false negatives rather than false positives,” countered Andrew Lacy, the founder and C.E.O. of Prenuvo.

In May, his company presented the results of a clinical study that followed 1,011 patients who underwent pre-emptive full body M.R.I. scans. (Not all experts took it seriously: “It is a retrospective and nonrandomized study,” said Kwee.) Of the patients, who were mostly asymptomatic, the screenings flagged potential signs of cancer in about 45 people. About half of those patients were later confirmed by biopsies to have cancer. The other half, of course, received biopsies they didn’t need.

In the case of Mr. Hogan, the Austin software C.E.O., the cancer which Prenuvo discovered had metastasized into his lungs, spleen, lower abdomen and bones. It was large B-cell lymphoma, an aggressive form. At the MD Anderson Cancer Center in Houston, Mr. Hogan began a regimen of chemotherapy and other treatments. Now in remission, he is “much more dialed in” to his health, he said: infrared saunas, cold plunge pools, red light therapy. “But the moral of the story is that if I hadn’t gotten this scan, it would probably have been game over for me.”