A new MRI company with a technological twist and a revolutionary vision to transform health and longevity by low cost MR screening for cancer and other diseases. Co-founders Raj Attariwala MD and Andrew Lacy MBA JD describe their fascinating journey and the challenges of early detection of disease.
Take away points:
-Cancer and other disease are 5-7 times more likely to kill you if detected late.
– A late diagnosis of a serious health condition often leads to a much worse outcome.
-Conditions such as aneurysms, dementia, stroke risk, IBD, colitis, kidney stones do not have very effective screening tests.
-Due to cost pressures in the health system, doctors may be discouraged from investigating low probability diagnoses, even if they have serious consequences for the patient.
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Robert Lufkin 0:01
Welcome back to the health longevity secrets show with Dr. Robert Lufkin. Today I’m joined by co founders of a new MRI company with a technological twist and a revolutionary vision to transform health and longevity by low cost Mr. screening for cancer and other diseases. Raj Qatari wala MD and Andrew Lacey MBA JD describe their fascinating journey and the challenges of early detection of disease. Before we begin, I’d like to mention that this show is separate from my teaching and research roles at the medical school to a chain currently associated. It is part of my continuing effort to bring quality evidence based information about health and longevity to the general public. Please enjoy this interview with Raj optare wala MD and Andrew Lacey MBA. JD. Hi everyone and welcome to our show. Today we’re going to hear about some revolutionary revolutionary new Mr. technology from the two co founders of a new company on how it may transform the way we look at Mr. screening for health and longevity. Andrew Lacey is the founder and CEO at pre nouveau health. He has an MBA from Stanford University, a JD, and law and Bachelor of economics from the University of Melbourne. He also has extensive experience taking digital products from conception to launch in a number of industries. Raj ATAR wala, is also co founder of renewable health. He’s dual board certified in radiology and nuclear medicine. He received his medical training at the University of British Columbia, with extra specialized training at Memorial Sloan Kettering Cancer Institute, UCLA, and USC. As if that’s not enough, he also holds a doctorate in biomedical engineering from Northwestern University. He’s pioneered advances in the field of whole body MRI through his work and authored numerous publications and presented International Medical conferences on whole body imaging and cancer detection. Welcome Raj, and Andrew to our show.
Raj Attariwala 2:15
Thank you, pleasure to be here. Great, great.
Robert Lufkin 2:19
Likewise, in and I share your vision for the power of Mr. screening, to improve our health and longevity, longevity, and also the sort of long term vision as lowering the price of the scan to you know, something that’s very affordable that may take as short as 15 minutes that, that we could even do it on an annual basis. It’s, it’s, it’s really very exciting. Maybe we could start off? Yeah, maybe we could start off just talking about? Yeah, how did how did you get here to to form this exciting company?
Raj Attariwala 2:59
Sure. So maybe I can kind of start with a bit of my, my unusual background. So I’m really an engineering medicine, sort of having done engineering first and then realize, like, wait a minute, it’s like, you know, how do things work and realize there’s a disk disconnection between the two fields of heavy science and engineering and, and medicine. And that actually occurred when we tried to get a robot into the O r, at, at Harvard Mass General. And so the surgeons convinced me as a crazy guy to go into medicine. So I was like, okay, you know, my, my, my PhD advisors, Famous Last Words are like, well, known candidates cheap, and the engineering world will always take you back. Fast forward 12 years, after medical school and a couple of residencies. And that’s where we sort of realized that, you know, how can we really kind of harness the power of nuclear medicine and apply it to something without radiation being MRI, and that’s where I really decided that, you know, I’m going to, basically, if I can’t find what I’m looking for, from a research point of view, I’m just gonna promote MRI machine. And so that’s what I did, and basically started to, you know, realize that there’s an entire world of MRI physicists out there who do sort of really amazing things that can’t understand medicine. So I became the translator between what I wanted from an imaging point of view to what we needed to create it. And so that was, that was how we started.
Andrew Lacy 4:24
So and then Raj and I met about two and a half years ago, I heard about this, just out of the grapevine is very impressive radiologist, up in British Columbia, Canada who’s doing these amazing scans. And being a curious person, I jumped on a plane, went to Vancouver, Canada, and sat inside the machine for I think at the time was about, you know, about about an hour. And as soon as I got out of the machine, I sat down with Raj and look through these images that he had taken and I had I was just completely floored I never before in my life had I had such a strong feeling that I was looking at something that was really the future of an industry. And, and so just the incredible depth and sort of diagnostic quality of the images that Raj had managed to take it. And I don’t want to, you know, take him 10 years to get to a point where we could do something in the speed that we were doing it. And and so we planned it out. About two years ago, we’ve been working together ever since to bring this to the rest of the world.
Robert Lufkin 5:32
Oh, that’s, that’s fascinating. I, I think, rise we may have overlapped a little at I’m based in California, I’m we may have overlapped at UCLA, perhaps I’m also based at USC now. So I know our journey, we probably know some of the same people that those institutions at least
Raj Attariwala 5:54
know for sure, like, I’m sure we do, because I got what I did is like, when I was doing nuclear medicine, afterwards, I started did a radiology nuclear medicine sandwich. But PET CT was just sort of, you know, really kind of coming into its prime for, you know, a cancer imaging modality. So I spent a lot of time at UCLA and, you know, work with some of the best people around as well at Sloan Kettering with some of the best people in PET CT. And then I captured a thing, and it’s like, you know, how do we actually take what we do in nuclear medicine? where, you know, we’re injecting radioactivity into somebody? And how do we move that or morph that into MRI? So one of the biggest things is for a screening test. We don’t want radiation, we don’t want an injection, it, it also came down to something really simple. It’s like, Okay, what would I want for myself or my family, or any loved ones? And that’s basically what what I started to build, you know, I had this unusual background, and the fact that I was like, wait, no, an MRI is just like a smartphone, it’s like, there’s all these people out there who can build things that I want. And, you know, On a hunch, I kind of thought, if I buy this right type of hardware, maybe I can get it to do things that have never been seen before. And you know, sure enough, over time, you know, as Andrew said, it took us several years, many years to get there. And then we wind up getting these sequences built, we built a lot of them ourselves, we made them bigger, better, faster. But most importantly, and this was one of the critical things is that they all had to be diagnostic. And so now there’s a lot of people who will actually kind of take an MRI machine and kind of, you know, put some new whiz bang sequence on it that nobody knows how to look at. Whereas, for me, what was really important is that, you know, every radiologist on the planet, who knows how to look at images can look at these and say, Wow, how do you do that? And, and that’s the important part, because, you know, there’s all these interesting tools that people kind of build and sort of bring into medicine that, you know, the vast majority of us physicians have no idea what to do with, we’re like, that’s cool. But how do I kind of get this out to everybody? And, you know, one of the things that actually had also the benefit of doing this, I decided, you know, after finishing all my training actually decided to go and work in a rural environment at work. You know, instead of, you know, even though I have this crazy academic background, I decided I’m going to go work rural to kind of see what, what does the average person out there want? What is the practical kind of no nonsense, useful stuff that is beneficial for every person? And then, you know, how do we actually implement that on an MRI machine? And that’s what, that’s what we built and looked at, how do we make it go faster and faster. And I used to do this unusual thing, where I would actually kind of meet with every single patient after an exam as a radiologist. So I think, you know, for example, like with Andrew, I’d, you know, I, the first time he came up, got a scan, and we sat in my little office, we had a big TV, and I kind of went through all the images with him. And, you know, you can actually, you know, almost prospectively tell patients, what their symptoms will be from the pictures, you know, because that’s what we’re doing. We’re looking at this, we’re talking to patients, and you know, as you know, from a medical point of view, like 70% of the history will tell you the diagnosis, right? If we have enough time to listen to patients, and you know, that that’s kind of what what we did. And so then when Andrew came along, we’re like, Well, how do we sort of reproduce that because there’s only a small handful of crazy radiologists like me, who are actually going to talk to people. And so that’s where Andrew came in. And we basically sort of reproduced my brain and in software, so that you can have all these images on your phone, you can have them accessible everywhere with the whole layman’s interpretation of what all it means, you know, like the, the real goal is that, you know, we know that knowledge is power. And we know that as physicians, we call the tremendous amount of knowledge. But the goal is to really sort of translate that down to the individual patient so that they’re actually empowered to really be advocates for themselves. And that’s how you get prevention. That’s how you get longevity by really educating patients instead of putting them in the driver’s seat for their own healthcare.
Robert Lufkin 9:51
Yes, certainly the idea of a patient seeing, seeing an image of an abnormality on their on their On their scan and then knowing that they can make choices in their lives over 12 months and and then get rescanned and see the the changes can be very very powerful I think you’re you’re you’re really onto something there and and just involving the patient in their care and seeing it on the pictures is is I think that’s going to be a game changer. Before we get too far into the into the details here and especially about your the the particular technological advantages of your product and and the delivery system. Before we do that maybe we could just take a few moments for our audience who may not be familiar with the subtleties between CT Mr. Plain films, ultrasound and CT pet, maybe maybe just map that out a little bit if you don’t mind raasch
Raj Attariwala 10:52
Sure, yeah, no, that’s a great question. So x ray, we all kind of know x ray, because when we learned the alphabet, that’s the only thing that shows up on the letter X. So but basically, actually, what we’re doing is we’re we’re taking high energy photons, and shining them through people are patient, and what it does, it actually looks at extremes of tissue density. So at one end, everything that’s black is gonna be air where the photon went right through and came out and exposed the X ray film. And on the other end, what we see is the very dense material of the bones, which wind up being white. and everything in between is kind of like a sort of fuzzy shade of grey, with the X ray ratio kind of going, I’m projecting a three dimensional object under a 2d picture. And then CT or computed tomography came around, which basically what it does, it takes an X ray beam and just spins it around your body, and effectively looks at it from multiple different directions, and then interpolates, what’s going on in the middle. So it actually allows us to see three dimensions of an X ray. Now the problem is with 3d is there’s a fair amount of radiation. And we know that radiation has a risk of inducing malignancy. You know, it’s, it’s one of the things that you, you know, when you need a CT, for diagnostic purposes, you need a CT. But if you’re looking at screening, you don’t want to do radiation. Now, when we move into the more advanced images, things like Positron Emission Tomography, or the entire field of nuclear medicine, what we’re doing is we’re actually taking radioactive material, we’re injecting it into your bloodstream. And we’re looking to see where it goes and collect. So for the for, let’s say, a nuclear medicine, bone scan, we’re taking an agent that, that that basically goes to where the bone is developing and, and being turned over and concentrates there. And then it actually allows us to pinpoint the problem and say, Oh, there it is. We have no idea what’s going on, we know that there’s an area that Bowens trip turning over quickly, is turning over quickly, because it’s broken. Is it turning over quickly because it’s infected? Or is it turning over quickly, because there’s a tumor in it, we have no idea, we can just see the problem. And so then we look at these other modalities such as CT or X ray, to actually help us diagnose what’s going on. And so then comes along Positron Emission Tomography, which is, again in the field of nuclear medicine. So what we’re doing with that, so tomography, just like computed tomography of CT, we’re taking a camera rotating around and we’re actually looking throughout the entire body and three dimensions. But in this case, the most common type for cancer imaging is we’re taking glucose, so the building block of every cell in our body, and we’re adding a radio label to it. So a radioactive fluorine to it, we inject it into the body. And where it goes in concentrates, is areas where you have increased tumor or cellular density. So most tumors, as we know, are hard. You know, for women, they used to say, you know, palpate, for your breast field for a lump, you know, so we know that those lumps are hard. And so what happens when those areas are hard is that there’s a area of increased cellular density, so a whole cluster of cells. Now the whole cluster of cells requires a lot of glucose to feed it. So with Positron Emission Tomography, you take FDG, glucose injected in and would concentrate on that area of increased cellular density. And that’s how we would find it.
Whereas with CT, in order to really be able to see what’s going on, we have to actually go in and do an injection so that we can actually see whether it increased blood flow to deliver that glucose to that hard lump of increase or density. So typically, for CT, we need an injection to see what’s going on to see blood flow. With Positron Emission Tomography, we’re looking at glucose concentration directly and in tumor cells. And now the problem with both CT and Positron Emission Tomography is that there is that radioactivity, so it’s not a great idea for for screening, because of the risk of of inducing cancer in a healthy population. When the population already has cancer, yes, that’s doesn’t matter. It’s like you need to figure out what’s going on with with that type of modality. And so after doing um, you know, working and understanding how that work that from from some of the best people in the world That’s where I kind of thought, well, in imaging, typically we just kind of look at an individual body part, it’s typically the size of an X ray piece of film. So you know, a chest X ray that’s we look at, we look at the head, or the neck or the chest or individual piece. And the reason why is because we can always bring somebody back and take another picture. Whereas in the field of nuclear medicine, because we’re injecting radioactivity, we basically want to look at everywhere where the person can go to school basically sort of scan from the top of the head to the feet, because we don’t want to bring them back and inject them with another heavy dose of radiation. So I kind of thought, Well, can we not do this with something like MRI, which has always been limited kind of little individual body parts. And that’s why as a crazy guy decided to say, Well, if I buy my own MRI machine with this unusual hardware, possibly we can make this mark. And then that’s what I realize is world of MRI physicists out there who were just basically like counting down my door to say, hey, you understand this, you understand that? Maybe like, Yes, I do. But this is what I want you to make me. And so you know, like that iterative cycle was was not fast. It was very, very complicated. But you know, that’s kind of where we are with with renouveau.
Robert Lufkin 16:10
Well, before we get on to renouveau, we, we hear a lot about ultrasound as a screening technique. And I understand ultrasound has no ionizing radiation. What are the trade offs with ultrasound versus CT versus Mr. prescreening?
Raj Attariwala 16:31
Yeah, no, that’s a great question. So SOS ultrasound. So we’re basically looking at high frequency waves in the megahertz range, so well above anything here. And what it actually does it actually like an echo, it penetrates through tissue and reflects off of whatever tissue it’s saying. But it’s basically only taking a slice through an individual part. And it’s very, very operator dependent. So what that means is, you know, if you have a good ultrasound technologist, you’re going to get a good study. If you don’t, you’re not. And one of the problems with ultrasound, as well as the bigger people are, the farther that echo has to travel, and the weaker it gets. And so as a result, you start to lose signal in bigger people that are large organs, like like the liver. So so that’s one of the weaknesses. Now one of the strengths of ultrasound is that we can use something called the Doppler effect, which is where we’re hearing a frequency increase as it’s coming towards you, then it decreases it goes away from you know, just like we talked about an ambulance, if you’re hearing a siren, you can tell which way it’s going based on the frequency shift. And so ultrasound uses that Doppler principle to to look at blood flow. And that’s really valuable, because, you know, again, we can see blood flow now in real time. Whereas all the other imaging modalities can look at blood flow in real time. So for a screening modality to look at, you know, things like the carotid arteries, which are nice and superficial, it actually works out quite well, because we’re, you know, there’s not a lot of depth to penetrate through, most of us don’t have big fat necks. And then as well, we can look at that blood flow and see how it’s changing over time with each heartbeat. Now, interestingly, you can do the exact same thing with MRI, but it’s very time consuming. And it’s just time consuming. So you know, we couldn’t do it, we actually used to play with it a lot. And it works very, very well. And now it is operator independent. But it is time consuming. And ultrasound is cheap and readily available. So that’s one of the big benefits of ultrasound. So that’s kind of how it works.
Robert Lufkin 18:37
Great. Yeah. And so, so that’s CTN, and PET scanning and nuclear medicine, scanning and ultrasound and plain film X ray. Now, how does Mr works so that it can do all these wonderful things without any ionizing radiation or without any potential harm to the patient?
Raj Attariwala 18:59
Yeah, now you get to the phone questions. So basically, you know, we try and think of MRI is something really complicated, but at least in my mind, it’s pretty simple. You know, it’s really nothing more than a hydrogen imager. So basically, our body is 70% water. And then we have a lot of hydrogen on fats. And so we basically go and look at those two frequencies and say, Hey, this is fat. This is water. And really, that that’s kind of how it’s working. So effectively, what we’re doing is, when somebody goes into an MRI room, we’re shielding out all the radio frequencies, all the Wi Fi, all the cell phone, everything else like that am radios, FM radios, it’s all blocked out in this room, what’s called a Faraday cage. And so when when we’re in there, what we’re doing is we’re actually going and orienting all the hydrogens in a certain way in your body. And then we actually go and we move them around. And so as they move around, they actually give off radio frequency and the am radio scale. And so what we do is we kind of go and we sort of, listen up, slice by slice. By slides and the beauty of it is we can orient those slices in any which way we want. Unlike CT, which has to be this way, we can orient it obliquely, we can do it any which way. So if somebody has like a really curved spine, we can straighten out the spine with MRI, just by saying, you know, we’re going to change our radio frequency waves or magnetic wave that we’re putting in, to be able to orient oriented. And so, in its simplest form, like said, an MRI is nothing more than hydrogen image imager, and we’re basically listening to the hydrogens on an am radio. Uh huh. The beauty of it is, you know, one of the things that we did in looking at you what are the potential risks in terms of getting out pretty well scan, you know, you’re in the machine for about an hour. And so we did a calculation on that, which is called SAR, which is specific absorption rate. And so any radio frequency, so your cell phone or anything else, like that has a solid calculation, because it’s got a, it’s a radio. And, and what we found is that, you know, getting us a scan is equivalent to talking on your cell phone for, you know, around three to four hours, probably less now. And cell phones get even more powerful. So, you know, and when we’re actually looking at a really low wavelength, we’re we’re basically looking at an am radio, you know, they’ve been around for the first radio developed. And so, you know, the, the amount of risk from that is, is incredibly low. risk.
Robert Lufkin 21:21
And to be clear, the the electromagnetic quote, radiation that’s used in an MRI scanner, is not ionizing. And so there’s there’s that risk for cancer that we see with x rays is not there. There may be some thermal effects with the SARS. But that’s just heating and as long as we don’t do too much, the Mr. Should be safe,
Raj Attariwala 21:45
then. Exactly. Yeah, it’ll be safe. Yeah. And it’s, it’s good. Go ahead, Andrew.
Andrew Lacy 21:53
Yeah, it’s adding, I think one of the things that Dr. Allen has been very sort of pioneering is in the use of a particular technique on MRI, both diffusion imaging, and this is really a, it’s a functional imaging technique, you know, in the same way that close friend Mr. topography is looking at tissue function. And it’s, you know, every year there are more and more studies looking at the benefits of these techniques for for lesion detection and discrimination. And this is really something that Raj incorporate into these protocols starting 10 years ago. So if you recall, Raj mentioned that achievement being identified cluster of cells, we, you know, he requires a lot more energy. And we see that energy in the form of glucose uptake on on PET CT, we see that that mass in the form of increased vascularity in the context of a contrast enhanced CT. On MRI, we see in fact, that dense mass itself, so whereas we PET CT, and with CT, we’re looking at, I guess, like these biomarkers of of potential, malignant Chima, we’re looking at the actual tumor itself. And so here are three different methodologies. They’re all looking at exactly the same thing. But the primary advantage of MRI is, of course, it doesn’t involve any radiation of the three modalities. It’s the only one that really is appropriate for screening in in sort of normal populations. Yeah, and
Robert Lufkin 23:30
I want to, I want to also specifically talk about the the unique advantages of the of the poll sequences or hardware that you’ve developed for a particular sort of differentiate this from, you know, any other Mr. stanner. Before we do that, one last question that just I always remember from medical school about looking at microscopes, and trying to looking at spatial resolution with microscopes. And that the, the limiting factor was the wavelength of the light. And that’s why light microscopes can only see down to a certain size, if you want to go more you switch to electron microscopes, and and you alluded to frequencies with ultrasound, transducer frequencies and in the megahertz. And if you want to increase that range, you can go down, I guess. And then I guess the question for our audience is with Mr. Do those spatial resolutions hold affects hold also? In other words, what’s the wavelength limitation on spatial resolution for Mr. What’s the wavelength of the electromagnetic radiation use for Mr. And if that’s not the limitation, what is?
Raj Attariwala 24:46
Yeah, that’s actually a great question. So so an MRI is actually a little bit different than all the other types like types of imaging, like surprisingly in terms of trying to slice something as thin as possible. highest resolution That’d be the whole X ray. Because it’s wavelength of light. Nothing has higher detail than than a plain film X ray. Everything else is less than that. But so when we look at, we call it a spatial resolution, then the other period that’s actually very, very powerful is what we call contrast resolution, basically seeing difference between tissue. And now, that’s where the field of nuclear medicine become very powerful. Because, yeah, we can, we can tell there’s a bone, we don’t get any detail on the bone. But we can see that there’s a big black spot that actually allows you to find a needle in the haystack. And so that’s kind of what we call spatial resolution, or I’m very contrast resolution. And so with MRI, you actually get to play between both. And it’s one of these things is actually trade offs, where you can decide, okay, how, how thin do I want to slice somebody, like we can basically, you know, we’re slicing somebody on the order of like, 1.2 millimeters, which is, you know, what are you going to do with less than that, it doesn’t help you. From a clinical point of view, it’s entirely useless. And it would take much more time to go thinner and thinner. But now, if you’re in the research world, for sure, you want to go thin. But from a practical clinical point of view, it adds nothing, no surgeons gonna operate on something less than one millimeter, or even practical reality, the knock can actually operate on anything less than a centimeter. So that’s the type of resolutions that we’re playing with it is anywhere between 1.2 and four to five millimeters on MRI is very, very similar for CT scan. So CT scanner, they started sliced thinner and thinner and thinner as the power on the machine got higher and higher. And then interestingly, radiologists have been saved. Now, I only want to look at it five millimeters, because the detail doesn’t offer us anything useful. You know, so that’s, so that’s kind of like roughly the level of resolution. And so when we talk about like, the clinical quality, like, that’s what we’re really looking at is like, what would the, you know, the best radiologists on the planet want to see, for their patient for their mother for their father for their sister, son, daughter. And that’s kind of what we what we targeted and this being our goal framework.
Robert Lufkin 27:06
Right. So, so now for, we’ve established that Mr. has significant Vantage advantages over these other techniques for screening, including lack of radiation and especial resolution. Now, you mentioned the diffusion imaging technique. Could you speak about because the fusion imaging is available in many different MRI scanners, I think general regular MRI scanners, but you have a particular unique, proprietary type of diffusion imaging that enables pre nouveau to do things that other companies can’t do. Could you talk to that a little bit so we can understand the advantage here and what you can do?
Raj Attariwala 27:48
For sure. So as you know, diffusion as a technique is basically so what revolutionized stroke imaging. So we could actually see cellular or sub cellular changes that would occur Well, before we saw that added development. So those sub cellular changes are what we call a functional problem. And then that’s the entire field of nuclear medicine is all about functional imaging, how does it work? What’s happening in this higher level. And so, in order to do diffusion, and do it very, very well, what we’re looking at, again, is basically hydrogen or water moving at very, very short periods of time. So every cell in the body has water in it, and outside of it, the cellular membrane. And so that water regulations were very tightly controlled. So what Dennis looby han discovered, I think, back in the 80s, is that in the brain, when you walk out blood flow to the brain, you wind up losing that water, you wind up actually losing that water pump that’s actually controlling the water balance of the in the brain. And that’s what we see now is a stroke. And so we can see that loss of water motion at a cellular level. Well, before we see the destructive changes that occur later on what we call an anatomic imaging, so works well for the brain, because it’s not moving. The head is very, very still, you know, typically, and so once we can lower down to the body, we actually run into all sorts of problems with people breathing, different patients sizes, most most people’s head, they’re roughly the same size. One of the other things that in the head, you basically have the brain use it’s 20% of your cardiac output. So it’s basically a heat sink. So you never have to worry about heating in the brain because it’s always been cooled by blood flow. So there’s all these kind of challenges and limitations that fall apart once you get below the below the below the head. And particularly when you get close to the diaphragm, you get like a lot of movement of diaphragm from breathing, you get cardiac pulsation, which is moving, moving and obviously we don’t want to stop and so that causes all sorts of problems as well with with motility. One of the other things with MRI, it actually struggles when you actually have what we call system. affability, which is between these different tissue types. So if you have bone, which contains no hydrogen, so it’s basically black and no signal. And then you have air, which also has no signal, and it’s black. And you put those besides something with signal in it, it actually causes distortion in the in the radio wave, it’s basically like a ripple. And so that gives us this susceptibility. So the bow, unfortunately, is full of gas, and very well gas unpredictable locations. And so that actually makes imaging far more challenging in the, in the abdomen, and now you’re going to couple the fact that we’re actually looking at water motion very, very quickly, it becomes incredibly hardware demanding. And so you need, you know, you really need like unique hardware to be able to solve that, that problem. And you know, all these different interplays, right have heating, you have resolution of both contrast and spatial resolution, you have frequency of scanning. So there’s, there’s a lot of variables that, you know, if you were to try and sort of build a sequence that you know, that there’s there’s close to about 150 parameters for like a single sequence in the in the abdomen that have to be modified to be able to create one of these. But you can only do that, when you have like the right hardware. You know, I say it’s very much like, you know, computer program, like if you have the most advanced, you know, cell phone or the most advanced smartphone around, you can build software to put on that, but you can’t put it on the original smartphone, the original iPhone did long run, you know, and so those are, those are some of the real key key features. So you kind of need to know how your hardware works to be able to program for it. And then you can actually like get get the types of images that we’re creating.
Robert Lufkin 31:43
That’s, that’s really exciting. So for, for our patients, our audience out there. To get this scan, we hear a lot about screening tests that are recommended imaging screening tests and other screening tests for for cancer and for other chronic diseases. What, what screening tests, does this address this, this scan that they would get? Ideally, maybe even once a year, but what tests will they not have to do otherwise, when they get this?
Raj Attariwala 32:19
Actually, there’s there’s actually a lot, you know, basically, we can actually, you know, detect nine of the 10 top cancers in stage one. The only cancer we can detect in stage one is leukemia, we’ll see that in stage three, whereas a blood test will pick it up in stage one. You know, for screening, I typically kind of say to people, look, there is no perfect test. We’re probably the best out there in terms of what we can detect, particularly when you’re screening because there’s no radiation. But more importantly, like, you know, lung cancer, breast cancer, pancreatic cancer, we can see colon cancer, we can see I hope to never see that but people get their colonoscopies, we might not see an early polyp, whereas a call where a colonoscopy can remove that polyp, but we will see colon cancer and particularly the hard ones that are hard for the colonoscopy, for colonoscopies to get all the way around to the secret bowl, because you’re basically kind of trying to backtrack around yourself, we’ve actually picked those up. And patients have actually had colonoscopy where that Super Bowl tumor has been missed, just because you can get there sometimes as well, renal renal cancer, multiple myeloma we can pick up so it’s, it’s pretty much you know, the the vast majority of everything that we can actually see an ovarian cancer, I think a really important one for for females, prostate cancer, in particular, prostate screening is one of the most powerful areas that MRI is now being used in general. And, you know, we talked about that diffusion tech diffusion technique. And for prostate imaging, it’s sort of becoming like the de facto gold standard for screening prostate in many countries. And again, they’re doing that without without contrast. And there’s a whole criteria that’s been been built to sort of compensate for weaker MRI machines where they happen, you know, those, those weaker machines, they’ll do what’s called a PI rads criteria where they’ll have to inject blood flow and contrast to look at the blood flow in the prostate. So those are, those are the types of things that we can see. And
Andrew Lacy 34:20
I was gonna say, like, from the context of a patient, you know, I largely think that what we do with renouveau really falls into two categories. There’s a bunch of stuff out there unfortunately, that either doesn’t have symptoms, or there aren’t good screening tests or or has confusion confusing. So the indeterminant symptoms like abdominal pain, and the and the previous scan is very good at picking up early some of these things that might kill you. And those obviously, you know, cancers or, or cerebral aneurysms, or AAA or there’s any number of things that they just aren’t really good tests for right now. But the second thing that I think is really I’m fat, you know, fascinating in some ways, it’s what drew me into working with with Raj is that there’s such that, you know, in the US, we have this sort of epidemic of, you know, chronic illness. And what we’re finding now that we’ve imaged 1000s and 1000s, and 1000s of people with this screening exam is that just how early we can pick up the signs of chronic conditions, such as, you know, small vessel ischemia, or spinal issues, stability issues, I mean, we can see these things, you know, five to 10 years before you might actually need surgery, and many years before, you might actually notice the symptoms, and it’s one of the sort of amazing and frustrating things about the human body is, it’s so plastic, that, you know, you can actually be causing a lot of underlying damage, and not even realize it, and your body happily compensates until they sort of reaches this point of no return. And then all of a sudden, you’re you have chronic disease, you have a liver that was like killing itself for many, many years. And all of a sudden, that just gives up. And so and so the, of course, when people think about getting a scan, that they’re generally thinking about, well, maybe this will catch something that might save my life, you know, now, but sort of what’s interesting for everyone is just to understand how the trajectory of the way that they live, their life is affecting, I guess, their body and this, you know, here, and we get into this term that you obviously very familiar with, which is sort of healthspan rather than just lifespan, you know, how long can you live that the mobile, engaging life? And, and I think there’s a lot of interesting biomarkers, or there’s just a lot of interesting motivation and enthusiasm, you can, I guess, catalyze, when you can show people exactly the effects of their lifestyle, you know, on sort of, like the underlying condition of their body.
Robert Lufkin 37:03
Yeah, that’s a great point, where we’re seeing in long in the longevity space, a lot of the the biomarkers for biological age versus chronological age, which is, of course, just our birth dates, things like the epigenetic methylation clocks, there’s now a consumer version of that and glycation clocks and proteomic clocks. Have you have you guys thought about doing a imaging based image biomarker clock sort of to calculate the biological age from their, from their pre novo for nuvo? scan?
Andrew Lacy 37:40
Yeah, no, I think it’s a really, it’s a very active area of research inside the company. It’s somewhat groundbreaking in the same way that the epigenetic clock is I mean, there’s not, you know, we’re really looking at sort of directionality, it’s very, these sort of studies are very, very difficult to sort of prove causation, because the studies take 20 or 30 years, so sort of, you know, any study where, you know, living longer is the goal, we’re typically not going to live long enough ourselves to actually sort of see the outcome of the study. And so and so what you tend to focus on is, you know, what is the science, you know, what is sort of what is the evidence pointing towards, as, you know, as sort of leading indicators for health, and I think a lot of those, not all of them, but sort of outside of metabolic sort of biomarkers that you can apply through a blood test, a lot of those are actually visible on MRI. So they’re just waiting there for us to, in some ways, incorporate them into the protocols, you know, incorporate them back into the, into the information that we provide back to the patient. So we’re working really actively on this right now, what’s really exciting, by the way, is, you know, MRI is very much a qualitative field. And so, you know, a radiologist might look at your liver and say, you know, you have mild or medium or severe, fatty liver. But you know, what you care about as a patient maybe is your, you know, liver fat percentage is x this year, and you’re going to work hard and change diet and lifestyle, and you want to see it, you know, x minus 2% next year, and so you can really start using these things to, in some ways, provide feedback for changes in lifestyle.
Robert Lufkin 39:24
That’s huge. That’s great. Yeah. And so patients want to get this scan that go to your website, do they need a doctor’s referral, or they can just sign up themselves?
Andrew Lacy 39:36
Well, we, the short answer is it depends on the state. longer answer is, we take referrals either from patients physician, or we. We’ve booked directly patients, but we involve a third party physician, in actually making a referral for us even in the states where we don’t really really require this. And the main reason for that is that, you know, unlike perhaps other tests in the longevity space, we really are taking clinical diagnostic images here. So there are real medical outcomes that oftentimes require quality of care. So we just want to make sure that there’s a physician involved that can then help follow up with any of you know, anything that might come out of the scan.
Robert Lufkin 40:27
And also for our audience, in addition to the sites, I think that you’re currently located at, maybe you could list those for us now. And in addition, before the show we were just talking about, you’re getting ready to announce some new Luke new locations that that will make this even more accessible for patients. Maybe you could, if you don’t mind, you could do that now.
Andrew Lacy 40:51
Yeah, I mean, it’s very exciting time for us to right in the middle of Coronavirus, we expanded from, from our original location of Vancouver, down to Silicon Valley. And it was just the timing was, you know, on the one hand by bad, you know, being that middle of lockdown. But on the other hand, we had so many patients that were actually flying in to Vancouver to get one of our screening exams, so much so that the customs at the border, I never quite believed them that people would be traveling from the US to Canada to get, you know, some form of medical treatment. And, and so we opened in Silicon Valley in October, and ever since then we’ll be going very well. And people have been flying across even during Coronavirus from the east coast and other locations to come and get one of these screening exams. And I think it speaks a lot to just the faith that a lot of physicians and patients have been helping us manage their health. And so, so we’re now looking at expanding to Southern California, so to Los Angeles region, and also over southern Florida. And over the course of the next year, we hope to open in many other locations as well. So we can bring this we can bring this exam closer to the people that can benefit from it. And obviously as a company so we can scale and continue to bring the price down. So the more more people can take advantage of the sort of insights that we give them about their health.
Robert Lufkin 42:15
Yeah, that’s, that’s so exciting. Maybe in the last last few minutes, we always ask our experts in addition to the exciting work they’re doing, we also ask them about their own personal lives and what life maybe you guys could comment on any lifestyle choices that you found to be particularly valuable looking at health and longevity, in addition to your in addition to getting a pre nuvo scan, of course. But anything with diet, exercise, supplements, are you taking rapamycin, Metformin, anything like that?
Andrew Lacy 42:56
Yeah, I’m actually speaking for myself. So, you know, I do take Metformin, I think, you know, I tend to keep a pretty watchful eye on that we’re all in the longevity space. So therefore, you know, I guess at a certain level, we all want to live longer, and sort of healthier lives. So I think that’s, I think Metformin is the one where there’s just, you know, a reasonably heavy body bag with evidence that it can, at a cellular level help inhibit cancer, very particular. So. So that one I’m taking about you, Rose, I know you investigated at one point, the diets on the body, and he has some interesting learnings.
Raj Attariwala 43:37
Yeah, no, we’ve actually sort of tried all the things, all sorts of interesting different things that we we tried to think where we actually went vegan for a month and scanned ourselves before and afterwards just to see what happened. With our bodies, we could actually be we’re looking at our visceral fat and our and our peripheral fat on the on the MRI machine, because we could quantify it and see it, that’s one of the research programs we’re working on is to be able to quantify visceral fat off scans. And so we tried it to see what happened because there was a movie that came out and one of the staff was like, Hey, we should try this, I said after Christmas. And it was actually really fascinating. So I have allergies, I’m just really, they’re just all nuts, peanuts, almonds, all of them. And so I found a real struggle to actually be trying to be vegan, because a lot of cashew replacements and not replacements. But one things that the movie did not tell us is that you have to exercise you can’t just do diet alone, because what actually happened is that we actually all wound up losing muscle mass, and actually gaining a little bit of fat. Whereas one person got a good exercise bike for Christmas. And she exercised and went vegan, and she actually gained muscle mass and got much healthier. So when we talk about diet and exercise, it’s not one, it has to be both. And you know, you can’t do one or the other. It’s really both. You need both. And so that’s kind of what I do. It’s like one of the you know, You know, being a Big East Indian person, it’s like, you know, male, we know that our risk of cardiovascular diseases is very high. You know, and so as a result, it’s like, what I try and do is basically, you know, walk as much as you can eat a little bit less I do my omega threes, because it’s one of the things that we know, well will work? Well, I have, I think one of the most fascinating tools that I actually have is a blood pressure wash, watch. So you can actually go and monitor blood pressure, basically, whenever you want. And that diurnal curve that we see during the day and at night, like sometimes at night, you know, you push the button on your watch, and it inflates a cough. And you can see exactly what’s what’s happening with your blood pressure. Sometimes you think, boy, I’m sleeping, I think I might be dead. I’ve never seen my blood pressure so low. But but it really is quite fascinating. That’s actually what triggered me to get into engineering school. To start with, I wanted to understand how the blood flow in the body work and in the eye. And because we would see that disease processes seem to manifest early in the morning when they pertained to blood flow. So there’s more strokes in the strokes in the morning. There’s more hypotensive episodes in the morning, blood coma progresses in the morning, all of these things. So so that’s one of the tools that I really like is this blood pressure watch.
Robert Lufkin 46:13
Raj Attariwala 46:15
it’s made by Omron I haven’t done it, it’s a little bit big, but I can kind of show you. So here it is. It’s great. And so it’s actually got a an inflatable cuff right here. And so it actually inflates right up when you put it on your wrist. And so you know it’s it’s fully FDA approved, you can actually get the the initial diurnal curve, you can basically all you have to do to activate you push this button in and inflates the cuff. You push here face to cuff here around your wrist. And it just listens for the systolic, you know, systolic, diastolic and you get it right here with your heart rate and everything. I love this thing.
Robert Lufkin 46:51
Now, I love it. We’ll put it in the show notes. We’ll put a link to it. Yeah. Yeah, no,
Raj Attariwala 46:55
definitely. It tells you when I’m stressed out, because my blood pressure goes up. And then and then you know, tells me what I need to like take calming deep breaths to slow down again to, you know, to bring the blood pressure down. We know the damaging effects of high blood pressure. So
Robert Lufkin 47:11
Oh, yeah. Oh, that’s great. Yeah. And Yep. Back Back to you, Andrew. On the on the Metformin comments. We’re gonna have nerve buyers ally on the show, who’s sort of the leader of the team study, which is his perspective, longevity study for Metformin. I think Nero has said publicly he’s taking 1500 milligrams a day of Metformin, long, long acting release himself. Also. I agree totally. Raj about exercise and and nutrition being hand in hand. Do you guys speaking of nutrition? Do you do any particular types of diet or time restricted feeding? We’re gonna have Jason funks partner, Megan Ramos on the show to talk about time restricted feeding. But do you? Do you do any of that?
Andrew Lacy 48:01
Well, I spent about four months last year doing intermittent fasting and ketogenic diets. So I definitely experiment with that, it’s very clear to me that I mean, it’s a I guess, like a sample of one, but at least as far as it relates to my body, it’s very clear that this is a healthy lifestyle. Now, the difficulty is, with most of the last oil changes is, you know, how do you sustain them in the context of building a business, I mean, it’s not very easy, there’s definitely like a slightly higher level of stress and a slightly lower level of sleep and all these things that are delayed, you know, if you’re stressing, I sleep much less inclined to eat it better. And so to exercise well, but you know, that’s sort of my personal struggle, it’s been very helpful for me, actually, I’m sort of one of the guinea pig guinea pigs on university. And so it’s, it’s not uncommon that might get scanned every two or three weeks, you know, when we try a new sequence or something. And the thing I find really amazing, it’s just how quickly stuff that’s going on in my life can manifest in my body, you know, like, I even I can see my, my spine straightening, like materially from, you know, having a couple of stressful weeks. And you can imagine, like, what you know, would be, you know, it’s definitely focused me on stress management, because, you know, I don’t feel any pain. I don’t want to have you know, a desk wants to start sleeping and never on slips, you know, you can, all you can do is really arrest the progress of these problems. And, you know, a pitcher sort of tells 1000 words, so for me, it’s been really motivational to help me also manage my stress levels, just seeing the impact that this can have on my body.
Robert Lufkin 49:33
Yeah, yeah, it’s really amazing. And, and we’re still learning so much, but I feel like we’re, this is really a revolutionary time in medicine for, for longevity and health and, and tools, like, like, you’re scanning that that’s going to empower people to, to make the right choices to change their lifestyle to to make themselves have better, better lives. It’s very Excited. Yeah,
Andrew Lacy 50:00
I would say one of the things that we’re really interested in interested in researching, and we’d love to actually partner with people do this. You know, I read a book about a med, Matthew Walker’s book about why we sleep. And, you know, he talks about the relationship between sleep and the size of the amygdala. But you know, the sample of patients that I think the study that he referenced was something like 30 patients. I mean, we know we’re in this fortunate position, where on the one hand, we’re capturing detailed medical histories. And on the other hand, we’re actually capturing detail, anatomical images of the entire body. So, you know, I would love to work with people to actually further the science there. I mean, why not replicate that body of 30 patients over 1000s of patients? Because that, you know, I think we’re looking in the same way we did with genetics, where you’re looking for sort of correlations between, you know, a genetic abnormalities, and it’s like it’s genotype phenotype. I think there’s, you know, we’re just starting to scratch the surface, where we can look for relationships between diet, exercise, stress, sleep, and trying to really understand at a well, first a lot of gross anatomical level, what effect is happening on our body, and that maybe, will help lead to different areas of inquiry about what’s going on at a split of biochemical level?
Robert Lufkin 51:20
Yeah, yeah, it’s a it’s a really hot area of research, we just spoke with Dr. Kara Fitzgerald, who you may know have just completed a a pilot study, but as prospective randomized trial of about 40 people have an eight week intervention of lifestyle change, and they did epigenetic methylation clocks before and after the trial. And they were able to show a reversal of three years on the methylation sites based on that there are a lot of questions still need to be worked out, you know, is methylation reversal, indicative of age reversal? Or is it just a phenotypic change, like taking your gray hair and dyeing it black, you know, or something like that. But, but there’s still a lot of interesting work and I’ll plug you in with some a number of people are doing studies looking at these things that the imaging component if you if you wanted to add that would be great. You know, people are showing just for brain scans like HIPAA hippocampal atrophy that everybody sees with, you know, Alzheimers disease and AP for people in the hippocampus. Researchers have been able to show they can actually reverse the hippocampal atrophy on the MRI scans after eight weeks of exercise or diet changes and, and other lifestyle things. So that’s really, really exciting what you’re doing.
Andrew Lacy 52:45
Well, I think if you are looking for early indicators of the need to fine, I mean, part of the problem of imaging and in particular MRI imaging is because it’s such an ordinarily such a was a very slow imaging modality, so therefore it becomes expensive. So it’s one of the last modalities that you end up using this, the same is true for PET CT. And so by the time you get someone in a PET CT machine to figure out their amyloid load, I mean, they’re already in advanced Alzheimer’s disease. So so you really need to, you need we need a lot more data up at the more normal end of the spectrum. Because what we will do is get a little more fidelity about what’s happening at the really early stages of disease. Because with that fidelity, we can you know, if we can identify earlier, the, you know, the the very early progression of these types of diseases in particular cognitive decline, it can, you know, they’re still lifestyle and notably, like exercise and diet. So the interventions that actually can, you know, worst case arrest that decline and best case possibly turn it around. Yeah, they usually need early indications.
Robert Lufkin 53:50
Yeah, yeah, that’s the whole there’s a whole movement in the Alzheimer’s community with speakers like Dr. Dale Bredesen from UCLA and us, you, UCSF who advocating widespread lifestyle changes for reversal and even preventing Alzheimer’s but he’s looking at, he’s looking at changes in the brain and hippocampal atrophy that occurred 10 years before mild cognitive impairment at all, impossibly as an early signal for Alzheimer’s and that’s when people need to start the prevention or start the treatment. If they wait until they have mild cognitive impairment, like you say, it’s later in the game and any treatments you do are going to be much less effective. But yeah, this is this has been so much fun talking to you guys. I can’t wait till you get the scan till you get set up here in Los Angeles. Maybe we can do another nother episode, we’ll go over and take a look at the facility there. That’ll that’ll be fascinating.
Raj Attariwala 54:59
For sure. Do we want to play?
Robert Lufkin 55:03
Yeah. So how can people we’re going to put the, your contacts in the show notes, any other any other thoughts you want to leave our audience with?
Where you’re doing his beautiful work, it’s gonna affect a lot of people. And I want to congratulate you on on what you what you’ve done and what you’re continuing to do. It’s very powerful.
Andrew Lacy 55:32
I mean, I think one one sort of parting thought for me would be, you know, when I first got my scan with Raj, I never actually fully understood how, you know, a little bit nervous, I didn’t think I would be. But as the day got closer, I was kind of bit nervous about what they might find. And it’s so funny this, you know, it’s sort of infuriating this human nature that we have that we don’t want to actually know what’s going on, you know, a lot of us have this sort of irrational fear. But I would say that the thing that I, you know, what I learned, luckily, Ries didn’t find anything in me, that was life threatening. And I just had this incredible sense of peace of mind for, you know, a month that was, you know, it’s almost like I woke up with a little bit of adrenaline, you know, the world’s in a little bit clearer and brighter and more colorful. And I think, in some ways, you know, we focus a lot on what we might see. But if anything, what we’re providing people with is peace of mind. And I think people really underestimate the power of that, you know, in helping us lead really sort of healthy and happy lives. It’s this, this is sort of underlying question of like, Well, you know, everything feels good. But you know, I got a cousin that died at this suddenly or mother died of that, and maybe I’m, you know, same things happening to me. So, you know, I think what’s great about all these new tests that are coming out is I think the more clarity we bring to our house, the more peace of mind we have, the more peace of mind we have the better lives, we
Robert Lufkin 56:56
can leave. That’s a beautiful thought. And we’ll we’ll leave with that. Thank you, Andrew. Thank you, Raj. Really appreciate the work you’re doing and thanks for being on the show. No, this is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have. Never disregard professional medical advice or delay in seeking of it because of something you’ve seen here. If you find this to be a value of you, please hit that like button and subscribe and support the work we do on this channel. Also, we take your suggestions and advice very seriously. Please let us know what you’d like to see on this channel. Thanks for watching and we hope to see you next time